Maternal Anxiety and the Second-Trimester Prenatal Screening: A Prospective Cohort Study

Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple screening and on maternal anxiety after receiving positive results. Methods: This prospective cohort study evaluated 1,595 pregnant women referred for prenatal visits. Maternal state/trait anxiety levels were measured, then quadruple screening was performed by measuring serum α-fetoprotein (AFP), β-human chorionic gonadotropin, inhibin A, and unconjugated estriol (UE3). After receiving the results, the state/trait anxiety was remeasured. Amniocentesis was performed for screening-positive mothers. Results: High prescreening maternal anxiety was associated with lower rates of elevated AFP (OR, 0.27; 95% CI, 0.1-0.74) and elevated inhibin A (OR, 0.38; 95% CI, 0.15-0.98). High maternal anxiety was associated with higher rates of decreased UE3 (OR, 1.8; 95% CI, 1.06-3.08). There were no significant associations between prescreening maternal anxiety and the final screening or amniocentesis results. Among the screening-positive mothers, those who had high state/trait anxiety before screening had higher anxiety scores after receiving positive results compared to those with low prescreening anxiety levels (52.9 ± 10.8 vs. 43.7 ± 10.3). Conclusion: High prescreening maternal anxiety is associated with lower rates of elevated AFP and inhibin A and higher rates of decreased UE3. However, maternal anxiety does not affect the final screening or amniocentesis result. High maternal state/trait anxiety before screening is associated with significantly higher maternal anxiety after the receipt of positive results.

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Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: A prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0245938 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245938

Author(s):

Francesca Bardi ◽

Merel Bakker ◽

Monique J. A. Kenkhuis ◽

Adelita V. Ranchor ◽

Marian K. Bakker ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Prospective Cohort Study ◽

False Positive ◽

Prospective Cohort ◽

Well Being ◽

Psychological Outcomes ◽

Structural Abnormalities ◽

Anxiety Levels ◽

Positive Results

Introduction The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women’s knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. Material and methods In a prospective-cohort study conducted between 2013–2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient’s positive-negative affect (PANAS) and ad-hoc designed questionnaires. Results Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). Conclusions The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities.

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The use of pre-operative virtual reality to reduce anxiety in women undergoing gynaecological surgeries: a prospective cohort study

10.21203/rs.3.rs-20956/v1 ◽

2020 ◽

Author(s):

Jason Ju In Chan ◽

Cheng Teng Yeam ◽

Hwei Min Kee ◽

Chin Wen Tan ◽

Rehena Sultana ◽

...

Keyword(s):

Virtual Reality ◽

Cohort Study ◽

Prospective Cohort Study ◽

Trait Anxiety ◽

Prospective Cohort ◽

New Technology ◽

Depression Scale ◽

Preoperative Anxiety ◽

Breathing Exercises ◽

Anxiety Depression

Abstract Background: Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition. There is limited work on VR effectiveness during the preoperative period in the local setting. We investigated the feasibility and practicability of employing VR in anxiety management for patients undergoing minor gynaecological surgery, with the primary outcome being the changes in preoperative anxiety levels before and after the VR experience. Methods: A prospective cohort study was conducted in the KK Women’s and Children’s hospital between March 2019 and January 2020. Female patients undergoing gynaecological surgeries were recruited after obtaining informed consent. Patients were given a VR headset accompanied with a handphone loaded with VR experiences comprising sceneries, background meditation music and breathing exercises. The VR experience was administered for 10 mins and pre- and post-VR psychological assessments surveys were conducted. Results: Data analysis from 108 patients showed that our patient population had moderate state anxiety (39.6 (SD 11.14) and trait anxiety 40.1 (9.07) on the State-Trait Anxiety Inventory (STAI). The use of VR before surgery could reduce both Hospital Anxiety and Depression Scale (HADS) anxiety (7.2 ± 3.3 down to 4.6 ± 3.0; p<0.0001) and depression (4.7 ± 3.3 down to 2.9 ± 2.5; p<0.0001) scores. EQ-5D-3Lshowed no significant change in dimensions of ‘mobility’ and ‘self-care’ but significant changes to reported ‘usual activities’, ‘pain/discomfort’ and anxiety/ depression’ dimensions. Level 1 for ‘usual activities’ (“no problems with performing usual activities”) increased from 102 (94.4%) to 107 (99.1%) (p= 0.0253), ‘pain/discomfort’ (“I have no pain/discomfort”) increased from 72 (66.7%) to 84 (77.8%) and ‘anxiety/ depression’ (“I am not anxious/ depressed”) increased from 62 (57.4%) to 90 (83.3%) between pre- and post-VR experience. About 82% of patients rated the VR experience as ‘Good’ or ‘Excellent’.Conclusions: Our study showed significant reduction in preoperative anxiety after VR experience and has positive patient satisfaction. The use of VR may be suitable for patients with high anxiety preoperatively without the use of anxiolytics. Future work could include implementation studies upon adoption in clinical practice and the use in other surgical populations. Trial registration: Clinicaltrials.gov NCT03685422. Registered 26Sep2018 https://clinicaltrials.gov/ct2/show/NCT03685422?term=NCT03685422&draw=2&rank=1

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