Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study

<div><p>In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.</p></div

Clusters with significant changes in DTI indices of white matter microstructure after a day of waking (TP1 compared with TP2).

<p>Clusters with significant changes in DTI indices of white matter microstructure after a day of waking (TP1 compared with TP2).</p

Changes in diffusion tensor imaging (DTI) indices of white matter microstructure after sleep deprivation and associations with sleepiness.

<p>(<b>A</b>) Significant decreases in fractional anisotropy (FA) after sleep deprivation (blue colors; left panel). (<b>B</b>) Significant decreases in axial diffusivity (AD) after sleep deprivation (blue colors; left panel). Averaged DTI values at time point (TP)2 and TP3 across significant voxels are shown for each participant using individual colors in the right panels of (<b>A</b>) and (<b>B</b>). Values from the same participant are connected with a line. (<b>C</b>) No significant relationship was observed between the decrease in FA in the voxels shown in (<b>A</b>) and Stanford Sleepiness Scale (SSS) score at TP3 (<i>R</i> = −0.33, <i>P</i> = 0.14). (<b>D</b>) Because the FA decreases in the significant voxels of (<b>A</b>) were mainly driven by AD reductions, we examined whether reductions in averaged AD within these clusters correlated with SSS score and found a significant negative association (<i>R</i> = −0.63, <i>P</i> = 0.002), indicating greater sleepiness in subjects with larger AD reductions after sleep deprivation. (<b>E</b>) No significant relationship was found between AD reductions across the voxels shown in (<b>B</b>) and SSS score (<i>R</i> = −0.26, <i>P</i> = 0.265). (<b>F,G</b>) Averaged AD across all voxels of the white matter skeleton decreased significantly from TP2 to TP3; this decrease was significantly correlated with sleepiness at TP3 (<i>R</i> = −0.65, <i>P</i> = 0.001). The left side of the brain images represents the right hemisphere.</p

Clusters with significant changes in DTI indices of white matter microstructure after sleep deprivation (TP2 compared with TP3).

<p>Clusters with significant changes in DTI indices of white matter microstructure after sleep deprivation (TP2 compared with TP3).</p

Data collection times.

<p>Data collection times.</p

Attention network task performance.

<p>Attention network task performance.</p

The relationship between orienting and HRV.

<p>Plots demonstrate the relationship between orienting and HRV at baseline (3A) after sleep (3B) and after sleep deprivation (3C). The blue histogram shows the posterior distribution for the correlation <i>p</i> with a 95% highest density interval (HDI). The scatterplots illustrate the relationships between these two variables, with superimposed posterior predictive distributions. The larger light blue ellipse shows the 95% highest density region while with smaller dark blue ellipse shows the 50% highest density region. The histograms on the top x-axes and right y-axes show the marginal distributions of the data. HDI = Highest density interval.</p