COMMENTARY

Prenatal Diagnosis: What About the Mother?

Jack Rychik, MD

Disclosures

September 11, 2012

Editorial Collaboration

Medscape &

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My name is Jack Rychik. I'm the Director of the Fetal Heart Program at the Cardiac Center of the Children's Hospital of Philadelphia.

In the current year, we are making very good [progress] in diagnosing various forms of congenital heart disease prior to birth. We can identify minute details of very complex structures even as early as 14-16 weeks' gestation. Making the diagnosis of congenital heart disease before birth provides multiple benefits. We can offer education to families. We can, most importantly, make a plan. When these babies come to term and they are ready for delivery, medication, care, and management can be offered to optimize the overall outcome for these patients.

What we have appreciated of late is that, by offering these fetal echocardiography services and making a diagnosis [of congenital heart disease], we create a potential for maternal stress. In essence, these are mothers who have been given this diagnosis in their fetus but then there are months that elapse before actual management takes place. This is a period of time with potential for significant stress.

We undertook a study where we offered psychometric testing to 59 consecutive mothers who came to the fetal heart program at the Cardiac Center of Children's Hospital of Philadelphia. We looked at posttraumatic stress, anxiety, and depression. Of note, we found that nearly 40% of our mothers had scores on the stress test that were consistent with posttraumatic stress disorder. Approximately 30% had evidence of anxiety and 22% had evidence of depression.

What this tells us is that, in addition to making the diagnosis of congenital heart disease, it is critically important, before birth, for us to recognize the stress that exists and to perhaps implement maneuvers and techniques to try to reduce stress in our families. Not only is this potentially beneficial, of course, to the mother and her level of anxiety during the pregnancy but there are some good data that suggest that reduction of maternal stress can also have secondary benefit to the fetus in terms of improving overall outcome.

This research is now laying the foundation and groundwork for further work in the area of maternal cortisol levels and looking at the biological impact of this stress on the fetus.

Thanks very much.

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