Paternal psychological response after ultrasonographic detection of structural fetal anomalies with a comparison to maternal response: a cohort study

Abstract

BackgroundIn Norway almost all pregnant women attend one routine ultrasound examination. Detection of fetal structural anomalies triggers psychological stress responses in the women affected. Despite the frequent use of ultrasound examination in pregnancy, little attention has been devoted to the psychological response of the expectant father following the detection of fetal anomalies. This is important for later fatherhood and the psychological interaction within the couple. We aimed to describe paternal psychological responses shortly after detection of structural fetal anomalies by ultrasonography, and to compare paternal and maternal responses within the same couple.MethodsA prospective observational study was performed at a tertiary referral centre for fetal medicine. Pregnant women with a structural fetal anomaly detected by ultrasound and their partners (study group,n=155) and 100 with normal ultrasound findings (comparison group) were included shortly after sonographic examination (inclusion period: May 2006-February 2009). Gestational age was >12 weeks. We used psychometric questionnaires to assess self-reported social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression): Impact of Event Scale. General Health Questionnaire and Edinburgh Postnatal Depression Scale. Fetal anomalies were classified according to severity and diagnostic or prognostic ambiguity at the time of assessment.ResultsMedian (range) gestational age at inclusion in the study and comparison group was 19 (12–38) and 19 (13–22) weeks, respectively. Men and women in the study group had significantly higher levels of psychological distress than men and women in the comparison group on all psychometric endpoints. The lowest level of distress in the study group was associated with the least severe anomalies with no diagnostic or prognostic ambiguity (p < 0.033). Men had lower scores than women on all psychometric outcome variables. The correlation in distress scores between men and women was high in the fetal anomaly group (p < 0.001), but non-significant in the comparison group.ConclusionSeverity of the anomaly including ambiguity significantly influenced paternal response. Men reported lower scores on all psychometric outcomes than women.This knowledge may facilitate support for both expectant parents to reduce strain within the family after detection of a fetal anomaly.

Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects

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“…[1, 2] To improve interventions to reduce distress, we need longitudinal information on different aspects of distress (e.g., emotional, cognitive, and behavioural data). In a study from Thailand among women carrying a fetus with an anomaly, only levels of anxiety were assessed.…”

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“…Men do, in fact, have negative feelings after a TOPFA. But fathers more quickly internalize their feelings and focus on practical tasks (e.g., arranging a funeral, caring for other children when their wife is unable, and returning to work [Kaasen et al 2013 ;Locock and Alexander 2006 ;). Additionally, clinical experience suggests that men fear that if they should express their emotions, their wife's sadness would be exacerbated.…”