Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Lou, Stina; Mikkelsen, Line Bang; Hvidman, Lone; Petersen, Olav Bjørn; Nielsen, Charlotte

doi:10.1111/aogs.12482

Cited by 46 publications

(30 citation statements)

References 41 publications

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“…Literature shows that having a high risk for aneuploidy significantly increases anxiousness in women (Lou et al 2015), and this was also observed in the women participating in our study. After women received a normal NIPT result there was a significant reduction in anxiety to levels considered normal (Bekker et al, 2003; Green et al 2004), although for 3% anxiety levels remained high.…”

Section: Discussionsupporting

confidence: 86%

“…The mere fact of having a prenatal test for fetal abnormalities may affect maternal anxiety (Nakic Rados et al 2013). Experienced levels of anxiety further increase upon receiving a high-risk result (Lou et al 2015). Anxiety is inversely correlated with, amongst others, socio-economic status (Faisal-Cury et al 2007), but might be contained by promoting informed choice for testing (Michie et al 2002).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, NIPT performed using whole-genome sequencing can lead to fetal and/or maternal secondary findings (Brady et al 2016), which might cause uncertainty. Studies amongst high-risk women undergoing confirmative invasive testing showed that their high levels of anxiety faded away after obtaining a normal result (Lou et al 2015). With regard to NIPT the literature shows mixed results, with some studies (Vanstone et al 2015; Wittman et al 2016) finding a negative (favorable) NIPT result is perceived as being reassuring, but others, although hypothetically addressed (Allyse et al 2014), have shown women still want further reassurance through invasive testing.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Women's Experience with Non‐Invasive Prenatal Testing and Emotional Well‐being and Satisfaction after Test‐Results

Schendel

Page-Christiaens

Beulen

et al. 2017

Journal of Genetic Counseling

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Increasingly, high-risk pregnant women opt for non-invasive prenatal testing (NIPT) instead of invasive diagnostic testing. Since NIPT is less accurate than invasive testing, a normal NIPT result might leave women less reassured. A questionnaire study was performed among pregnant women with elevated risk for fetal aneuploidy based on first-trimester combined test (risk ≥1:200) or medical history, who were offered NIPT in the nationwide Dutch TRIDENT study. Pre- and post-test questionnaires (n = 682) included measures on: experiences with NIPT procedure, feelings of reassurance, anxiety (State-Trait Anxiety Inventory, STAI), child-related anxiety (PRAQ-R), and satisfaction. The majority (96.1%) were glad to have been offered NIPT. Most (68.5%) perceived the waiting time for NIPT results (mean: 15 days, range 5–32) as (much) too long. Most women with a normal NIPT result felt reassured (80.9%) or somewhat reassured (15.7%). Levels of anxiety and child-related anxiety were significantly lower after receiving a normal NIPT result as compared to the moment of intake (p < 0.001). Women with inadequate health literacy or a medical history (e.g. previous child with trisomy) experienced significantly higher post-test-result anxiety (Mean (M) STAI = 31.6 and 30.0, respectively) compared to those with adequate health literacy (M = 28.6) and no medical history (M = 28.6), indicating these women might benefit from extra information and/or guidance when communicating NIPT test-results. Introducing NIPT as an alternative to invasive testing, led to an offer that satisfied and largely reassured high-risk pregnant women.Electronic supplementary materialThe online version of this article (doi:10.1007/s10897-017-0118-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Women's Experience with Non‐Invasive Prenatal Testing and Emotional Well‐being and Satisfaction after Test‐Results

Schendel

Page-Christiaens

Beulen

et al. 2017

Journal of Genetic Counseling

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“…Quantitative studies have found a significant increase in anxiety following a positive screening result [2], and qualitative studies have investigated the complex information and burdensome decision-making that high-risk women face [3–5]. Invasive diagnostics (chorionic villus sampling (CVS) or amniocentesis) will provide a definite answer, but carry a small procedure-related risk of miscarriage.…”

Section: Introductionmentioning

confidence: 99%

Coping with worry while waiting for diagnostic results: a qualitative study of the experiences of pregnant couples following a high-risk prenatal screening result

Lou

Nielsen

Hvidman

et al. 2016

BMC Pregnancy Childbirth

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BackgroundIt is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally ‘on hold’ during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty.MethodsQualitative, semi-structured interviews with 16 high-risk couples who underwent diagnostic testing. The couples were recruited at a university hospital fetal medicine unit in Denmark. Data were analysed using thematic analysis.ResultsAll couples reported feeling worried and sad upon receiving a high-risk screening result. While waiting for diagnostic results, the couples focused on coming to their own understanding of the situation and employed both social withdrawal and social engagement as strategies to prevent worry from escalating. Additionally, couples used gratitude, reassuring reasoning and selective memory as means to maintain hopes for a good outcome. Discussions about what to do in case of an abnormal test result were notably absent in the accounts of waiting. This bracketing of the potential abnormal result allowed the couples to hold on to a ‘normal’ pregnancy and to employ an ‘innocent-till-proven-guilty’ approach to their worries about the fetus’s health. None of the interviewed couples regretted having prenatal screening and all of them expected to have prenatal screening in a future pregnancy.ConclusionsThe couples in this study did not put the pregnancy mentally ‘on hold’. Worry and uncertainty must be understood as managed through a diverse range of practical and emotional strategies that change and overlap in the process of waiting. Clinicians may support appropriate ways of coping with worry and waiting through empathetic and empowering clinical communication. In addition to providing adequate information and presenting options available, clinicians may support high-risk women/couples by encouraging them to seek their own personal understandings and management strategies as a way to gain some control in an uncertain situation.

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“…The decision about whether or not to take the prenatal test for Down syndrome (DS) is a difficult one [1, 2]. Future parents have to decide in a context of uncertainty where results cannot be predicted or guaranteed [3–5].…”

Section: Introductionmentioning

confidence: 99%

What factors influence health professionals to use decision aids for Down syndrome prenatal screening?

Lépine¹,

Portocarrero²,

Delanoë³

et al. 2016

BMC Pregnancy Childbirth

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BackgroundHealth professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up.MethodsWe planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews.ResultsOut of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues’ approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a relevant source of information (n = 24, 67 %, motivation and goals domain); and 6) not knowing any PtDAs (n = 23, 64 %, knowledge domain).ConclusionsAppraisal, PtDA availability, peer approval, time concerns, evidence and PtDA awareness all affect whether health professionals are likely to use a PtDA to help pregnant women make informed decision about Down syndrome screening. Implementation strategies will need to address these factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1053-2) contains supplementary material, which is available to authorized users.

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Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Abstract: Studies using quantitative, validated measures to estimate anxiety showed no association between screening and residual anxiety.

Cited by 46 publications

References 41 publications

Women's Experience with Non‐Invasive Prenatal Testing and Emotional Well‐being and Satisfaction after Test‐Results

Women's Experience with Non‐Invasive Prenatal Testing and Emotional Well‐being and Satisfaction after Test‐Results

Coping with worry while waiting for diagnostic results: a qualitative study of the experiences of pregnant couples following a high-risk prenatal screening result

What factors influence health professionals to use decision aids for Down syndrome prenatal screening?

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