Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms

Abstract

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn’t for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI–State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.

Impact of laser therapy for twin‐to‐twin transfusion syndrome on subsequent pregnancy

“…Finally, the treatment and the monitoring of TTTs are highly anxiogenic and may cause psychological disorders during subsequent pregnancies. 22 In our study, the prevalence of anxiety in subsequent pregnancies was as high as 39.2%, although the difference with the control group was not significant. Most of these women described a permanent "fear of losing the baby."…”

Prenatal Attachment in Twin Pregnancy

“…Despite previous works on prenatal attachment in mother of twins observed that it may be a risk factor for the development of a close and positive relationship between the mother and the babies, as far as we know, only six studies explored prenatal attachment in twin pregnancies [13,19,48,[75][76][77].…”

“…In particular, it was showed that the increase of prenatal attachment in the last trimester of pregnancy, usually described in singleton pregnancies [78], was observed both in dichorionic and uncomplicated monochorionic pregnancies, while this intensification was not observed in pregnancies complicated by TTTS. The fear represented by the high risk associated to TTTS pregnancies, the uncertainty for the pregnancy outcome and the doubt for the health of the fetus seemed to reduce prenatal attachment [13].…”

“…Different researches tried to evaluate the association between the presence of mood disorders and stress in parents and twin pregnancies. Researchers that focused on parental experience associated to twin pregnancy that occurs both naturally or with ART investigated either the joint experience of mothers and fathers [9][10][11][12] or of mothers alone [13][14][15][16]. It was observed that the risks usually associated to twin pregnancy lead to higher level of stress [17] and seemed to increase the incidence of depression and anxiety in parents of twins and especially in mothers [6, 9-11, 16, 18].…”

Yüksek Riskli Gebelerde Anksiyete ve Depresyon ile Hemşirelik Bakım Memnuniyetinin İncelenmesi

“…Sağlıklı gebelerde gebelik haftası ilerledikçe yaklaşan doğum sürecinin etkisi ile kaygı ve depresyon artmaktadır [25]. Ancak Fransa ve Almanya'da riskli gebelerle yapılan çalışmalarda anksiyetenin gebelik ilerledikçe bizim çalışmamıza benzer şekilde azaldığı görülmektedir [26,27]. Gouronti ve ark.…”