Main Article Content
Invasive prenatal diagnosis (PND) through amniocentesis and chorionic villus sampling (CVS) can detect Down syndrome. Pregnant women usually experience a variety of psychological responses associated with invasive PND. This study is intended to assess depression, anxiety and stress levels and the factors related to their psychological responses in pregnant women with invasive prenatal diagnosis of Down syndrome.
A cross sectional study was conducted at Kandang Kerbau Women’s and Children’s Hospital, Singapore. The psychological responses of 70 women undergoing PND were assessed by Depression Anxiety Stress Scale 21 (DASS 21) questionnaire. A multiple linear regression analysis was used to analyze association between knowledge and perceived risk with psychological responses (CI 95% and significance value p<0.05).
More than half of the participants had normal anxiety (55.7%), stress (72.8%), depression levels (65.8%). The results revealed significantly higher level of anxiety in women with gestational age >13 weeks who had pursued amniocentesis. Women with no previous children had higher levels of depression and stress. Women who pursued amniocentesis had significantly higher anxiety scores compared to women undergoing CVS (p=0.015).
Women’s psychological responses are associated with gestational age, type of procedure and parity. The level of anxiety increased in women who underwent amniocentesis for diagnosis of Down syndrome. Knowledge and perceived risk of having a baby with Down syndrome do not seem to have psychological effects to women.
Kowalcek I. Stress and anxiety associated with prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2007;21:221-8.
Csaba A, Bush MC, Saphier C. How painful are amniocentesis and chorionic villus sampling? Prenat Diagn 2006;26:35-8.
Allison JS, Stafford J, Anumba DOC. The effect of stress and anxiety associated with maternal prenatal diagnosis on feto-maternal attachment. BMC Womens Health 2011;11:33. doi: 10.1186/1472-6874-11-33.
El-Hage W, Leger J, Aude D, et al. Amniocentesis, maternal psychopathology and prenatal representations of attachment: a prospective comparative study. PLoS ONE 2012;7:e41777. doi: 10.1371/journal.pone. 0041777.
Sahin NH, Ilkay G. Congenital anomalies: parents’ anxiety and women’s concern before prenatal testing and women’s opinion towards the risk factors. J Clin Nurs 2008;17:827-36.
Rowe H, Fisher J, Quinlivan J. Are pregnant Australian women well informed about prenatal genetic screening: a systematic investigation using multidimensional measures of informed choice. Aust NZ J Obstet Gynaecol 2006;46:433-9.
Berg VDM, Danielle RMT, Dirk LK. Understanding pregnant women’s decision making concerning prenatal screening. Health Psychol 2008;25:430-7.
Buckley F, Buckley S. Wrongful deaths and rightful lives : screening for Down syndrome. Down Syndrome Res Pract 2008;12:79-86. doi: 10.3104/editorials.2087
Schoonen M, Wildschut H, Essink-Bot ML, Peters I, Steegers E, de Koning H. The provision of information and informed decision making on prenatal screening for Down syndrome: a questionnaire and register based survey in a non selected population. Patient Educ Couns 2011; 87:351-9.
Ohman SG, Charlota G, Ulla W. Perception of risk in relation to ultrasound screening for Down syndrome during pregnancy. Midwifery 2009;25: 264-76.
Caughey AB, Washington AE, Kupperman M. Perceived risk of prenatal diagnostic procedure-related miscarriage and Down syndrome among pregnant women. AJOG 2008;333:1-8. doi: org/10.1016/j.ajog.2007.09.045.
Conversano C, Alessandro R, Elena L, et al. Optimism and its impact on mental and physical well being. Clin Pract Epidemiol Ment Health 2012;6:25-9. doi: 10.2174/174501790100601 0025.
Nes LS, Segerstrom SC. Dispositional optimism and coping: a meta-analytic review. Pers Soc Psychol Rev 2006;10:235–51.
Milic BB, Tamara MD, Karin KO, et al. Stress and anxiety in relation to amniocentesis: do women who perceive their partners to be more involved in pregnancy feel less stressed and anxious? Croat Med J 2010;51:137-43.
Rasmussen HN, Wrosch C, Scheier MF, et al. Self-regulation processes and health: the importance of optimism and goal adjustment. J Personal Disord 2006;74:1721-48.
Schou I, Ekeberg O, Ruland CM. The mediating role of appraisal and coping in the relationship between optimism-pessimism and quality of life. Psychooncology 2005;14:718-27.
ZM Podolska, Majkowicz M, Sipak SO, et al. Ways of coping in stressful situation and anxiety state or anxiety trait among women with symptoms of perinatal depression. Ginekol Pol 2009;80:201-6.
V Beck, Enzlin P, Done E, et al. Psychosocial aspects of invasive fetal therapy as compared to prenatal diagnosis and risk assessment. Prenat Diagn 2013;33:334-40.
Sarkar P, Bergman K, O’Connor TG, et al. Maternal antenatal anxiety and amniotic fluid cortisol and testosterone: possible implication for foetal programming. J Neuroendocrinol 2008;20: 489-96.
Durand MA, Stiel M, Boivin J, et al. Information and decision support needs of parents considering amniocentesis: interviews with pregnant women and health professionals. Health Expect 2010;13:125-38. doi: 10.1111/j. 1369-7625.2009.00544.x.
Coleman PK, Coyle CT, Rue VM. Late term elective abortion and susceptibility to posttraumatic stress symptoms. J Pregnancy 2010. Article ID 130519, 10 pages, 2010. doi: 10.1155/2010/130519.
Kersting A, Kroker K, Steinhard J, et al. Psychological impact on women after second and third trimester termination of pregnancy due to fetal anomalies versus women after preterm birth- a 14 month follow up study. Arch Womens Ment Health 2009;12:193-201.
Alhausen JL. A literature update on maternal-fetal attachment. J Obstet Gynecol Neonatal Nurs 2008;37:315-28. doi: 10.1111/j.1552-6909. 2008.00241.x.
Sockol LE, C Neil E, Jacques PB. The relationship between maternal attitudes and symptoms of depression and anxiety among pregnant and postpartum first-time mothers. Arch Womens Ment Health 2014;17:199-212.