Fetal Echocardiography: Is an Anxiety and Stress Factor for Mother and Fetus?

Year 2023, Volume: 14 Issue: 3, 390 - 396, 10.07.2023

Mehmet Akif Akıncı Necati Uzun Hayrullah Alp Mesut Küçükosmanoğlu

https://doi.org/10.31067/acusaglik.1194354

Abstract

Purpose: There are conflicting data about the effects of fetal echocardiography (fECHO) on the psychiatric symptoms of the mother and cardiac evaluation of the fetus.
Methods: This study included 119 pregnant women who evaluated using fECHO as the study group and 65 healthy pregnant women who evaluated using ultrasonography for routine screening as the control group. All participants filled out State and Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Beck Depression Inventory (BDI) before assessment.
Results: Mitral flow velocity, Tricuspid flow velocity, Aorta flow velocity (AFV), Pulmonary artery flow velocity, Fetal heart rate (FHR) was evaluated by fECHO. STAI-S, STAI-T and PSS scores of women who evaluated by using fECHO were higher than the control group. In fECHO group, AFV values of pregnant women with high STAI-S scores were higher than those with low STAI-S scores. FHR was higher in pregnant women with low STAI-T scores compared to pregnant women with high STAI-T scores. Correlation analyses showed that STAI-S scores and AFV values and number of pregnancies were positively correlated. FHR was found to be negatively correlated with STAI-S, STAI-T and PSS scores.
Conclusion: fECHO can cause anxiety and stress in pregnant women and may have negative effects on fetal cardiac evaluation.

Keywords

anxiety, depression, fetal echocardiography, maternal, stress

References

• 1. Zhang Y-F, Zeng X-L, Zhao E-F, Lu H-W. Diagnostic value of fetal echocardiography for congenital heart disease: a systematic review and meta-analysis. Medicine. 2015;94(42).
• 2. Small M, Copel J. Indications for fetal echocardiography. Pediatric cardiology. 2004;25(3):210-22.
• 3. Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak PJ, et al. American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. Journal of the American Society of Echocardiography. 2004;17(7):803-10.
• 4. Donofrio MT. Predicting the future: delivery room planning of congenital heart disease diagnosed by fetal echocardiography. American journal of perinatology. 2018;35(06):549-52.
• 5. Achiron R, Glaser J, Gelernter I, Hegesh J, Yagel S. Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies. British Medical Journal. 1992;304(6828):671-4.
• 6. Sklansky M, Tang A, Levy D, Grossfeld P, Kashani I, Shaughnessy R, et al. Maternal psychological impact of fetal echocardiography. Journal of the American Society of Echocardiography. 2002;15(2):159-66.
• 7. Björkhem G, Jörgensen C, Hanséus K. Parental reactions to fetal echocardiography. Journal of Maternal-Fetal Medicine. 1997;6(2):87-92.
• 8. Rosenberg KB, Monk C, Glickstein JS, Levasseur SM, Simpson LL, Kleinman CS, et al. Referral for fetal echocardiography is associated with increased maternal anxiety. Journal of Psychosomatic Obstetrics & Gynecology. 2010;31(2):60-9.
• 9. Eurenius K, Axelsson O, Gällstedt‐Fransson I, Sjöden PO. Perception of information, expectations and experiences among women and their partners attending a second‐trimester routine ultrasound scan. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1997;9(2):86-90.
• 10. Cristofalo E, Dipietro J, Costigan K, Nelson P, Crino J. Women's response to fetal choroid plexus cysts detected by prenatal ultrasound. Journal of Perinatology. 2006;26(4):215-23.
• 11. Georgsson Öhman S, Saltvedt S, Waldenström U, Grunewald C, Olin‐Lauritzen S. Pregnant women's responses to information about an increased risk of carrying a baby with Down syndrome. Birth. 2006;33(1):64-73.
• 12. Kowalcek I, Huber G, Mühlhof A, Gembruch U. Prenatal medicine related to stress and depressive reactions of pregnant women and their partners. 2003.
• 13. Leuthner S, Bolger M, Frommelt M, Nelson R. The impact of abnormal fetal echocardiography on expectant parents’ experience of pregnancy: a pilot study. Journal of Psychosomatic Obstetrics & Gynecology. 2003;24(2):121-9.
• 14. Kowalcek I, Ruber G, Bieniakiewitz I, Lammers C, Brunk I, Gembruch U. The influence of gestational age on depressive reactions, stress and anxiety of pregnant women and their partners in relation to prenatal diagnosis. Journal of Psychosomatic Obstetrics & Gynecology. 2003;24(4):239-45.
• 15. Flynn HA, McBride N, Cely A, Wang Y, DeCesare J. Relationship of prenatal depression and comorbidities to infant outcomes. CNS spectrums. 2015;20(1):20-8.
• 16. Rondó PH, Ferreira RF, Nogueira F, Ribeiro MC, Lobert H, Artes R. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. European journal of clinical nutrition. 2003;57(2):266-72.
• 17. Ding X-X, Wu Y-L, Xu S-J, Zhu R-P, Jia X-M, Zhang S-F, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. Journal of affective disorders. 2014;159:103-10.
• 18. Glover V. Annual research review: prenatal stress and the origins of psychopathology: an evolutionary perspective. Journal of Child Psychology and Psychiatry. 2011;52(4):356-67.
• 19. Talge NM, Neal C, Glover V, Early Stress TR, Fetal PSN, Child NEo, et al. Antenatal maternal stress and long‐term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry. 2007;48(3‐4):245-61.
• 20. Spielberger CD, Gorsuch R, Lushene R, Vagg P, Jacobs G. State-trait anxiety inventory. Palo Alto. CA: Mind Garden. 1983.
• 21. Öner N, Le Compte vA. State-trait anxiety inventory handbook. Bogazici University, Istanbul, Turkey. 1985.
• 22. Tendais I, Costa R, Conde A, Figueiredo B. Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI. The Spanish journal of psychology. 2014;17.
• 23. Grant K-A, McMahon C, Austin M-P. Maternal anxiety during the transition to parenthood: a prospective study. Journal of affective disorders. 2008;108(1-2):101-11.
• 24. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of health and social behavior. 1983:385-96.
• 25. Eskin M, Harlak H, Demirkıran F, Dereboy Ç, editors. Algılanan stres ölçeğinin Türkçeye uyarlanması: güvenirlik ve geçerlik analizi. New/Yeni Symposium Journal; 2013.
• 26. Gholipoor P, Saboory E, Ghazavi A, Kiyani A, Roshan-Milani S, Mohammadi S, et al. Prenatal stress potentiates febrile seizure and leads to long-lasting increase in cortisol blood levels in children under 2 years old. Epilepsy & Behavior. 2017;72:22-7.
• 27. Andreou E, Alexopoulos EC, Lionis C, Varvogli L, Gnardellis C, Chrousos GP, et al. Perceived stress scale: reliability and validity study in Greece. International journal of environmental research and public health. 2011;8(8):3287-98.
• 28. Beck AT, Ward C, Mendelson M, Mock J, Erbaugh J. Beck depression inventory (BDI). Arch Gen Psychiatry. 1961;4(6):561-71.
• 29. Hisli N. Beck Depresyon Envanterinin gecerliligi uzerine bit calisma (A study on the validity of Beck Depression Inventory.). Psikoloji Dergisi. 1988;6:118-22.
• 30. Wright L, Stauffer N, Samai C, Oster M. Who should be referred? An evaluation of referral indications for fetal echocardiography in the detection of structural congenital heart disease. Pediatric cardiology. 2014;35(6):928-33.
• 31. Alp H, Küçükosmanoğlu M, Sever B, Baran C, Sevgili M, Elmacı AM, et al. Congenital Heart Diseases Detected by Prenatal Fetal Echocardiography and Associated Extracardiac Anomalies. The Journal of Pediatric Research. 2019;6(4):280-5.
• 32. Simó S, Zúñiga L, Izquierdo MT, Rodrigo MF. Effects of ultrasound on anxiety and psychosocial adaptation to pregnancy. Archives of women's mental health. 2019;22(4):511-8.
• 33. Hoskovec J, Mastrobattista JM, Johnston D, Kerrigan A, Robbins‐Furman P, Wicklund CA. Anxiety and prenatal testing: do women with soft ultrasound findings have increased anxiety compared to women with other indications for testing? Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2008;28(2):135-40.
• 34. Channing A, Rosenberg K, Monk C, Kleinman CS, Glickstein JS, Levasseur SM, et al. Maternal anxiety associated with fetal echocardiography. 2012.
• 35. Van den Bergh BR, Mulder EJ, Mennes M, Glover V. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neuroscience & Biobehavioral Reviews. 2005;29(2):237-58.
• 36. Wu Y, Lu Y-C, Jacobs M, Pradhan S, Kapse K, Zhao L, et al. Association of prenatal maternal psychological distress with fetal brain growth, metabolism, and cortical maturation. JAMA network open. 2020;3(1):e1919940-e.
• 37. Monk C, Fifer WP, Myers MM, Sloan RP, Trien L, Hurtado A. Maternal stress responses and anxiety during pregnancy: effects on fetal heart rate. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology. 2000;36(1):67-77.
• 38. Sjöström K, Valentin L, Thelin T, Maršál K. Maternal anxiety in late pregnancy and fetal hemodynamics. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1997;74(2):149-55.
• 39. Kim YJ, Park Y-J. Effect of structured bed exercise on uterine contractions, fetal heart rate patterns, and maternal psychophysical symptoms of hospitalized high-risk pregnant women: a randomized control trial. Asian nursing research. 2018;12(1):1-8.
• 40. Lobmaier SM, Müller A, Zelgert C, Shen C, Su P, Schmidt G, et al. Fetal heart rate variability responsiveness to maternal stress, non-invasively detected from maternal transabdominal ECG. Archives of gynecology and obstetrics. 2020;301(2):405-14.
• 41. Faravelli C, Lo Sauro C, Lelli L, Pietrini F, Lazzeretti L, Godini L, et al. The role of life events and HPA axis in anxiety disorders: a review. Current pharmaceutical design. 2012;18(35):5663.
• 42. Henry JP. Biological basis of the stress response. Integrative physiological and behavioral science. 1992;27(1):66-83.
• 43. Steudte S, Stalder T, Dettenborn L, Klumbies E, Foley P, Beesdo-Baum K, et al. Decreased hair cortisol concentrations in generalised anxiety disorder. Psychiatry research. 2011;186(2-3):310-4.