Expectant mothers who learn from prenatal diagnosis that they are carrying a fetus with a congenital heart defect (CHD) commonly suffer post-traumatic stress, depression and anxiety. However, a healthy relationship with one's partner and positive coping mechanisms can reduce this intense stress, according to new research from the Cardiac Center of The Children's Hospital of Philadelphia.  The study is published in the September 2012 issue of The Journal of Pediatrics.

Heart defects are the most common form of congenital malformations affecting newborns. Infants who were prenatally diagnosed with congenital heart disease (CHD) are more stable and have better outcomes than infants who were diagnosed after birth. Diagnosing CHD in a fetus also allows mothers to educate themselves on heart malformations, consider their options, and potentially plan for intervention or surgery after birth.

The prenatal diagnosis of CHD is a stressful event for parents, which can affect mood and anxiety. Maternal stress has been linked to fetal disturbances in the hypothalamic-adrenal-pituitary system, poor intrauterine growth, preterm birth, and newborns who are small for gestational age (associated with childhood attention and learning difficulties, anxiety, and depression). Therefore, healthy partner relationships and positive coping mechanisms are important for pregnant women to successfully deal with stress. Jack Rychik, MD, at the Fetal Heart Program at The Cardiac Center at The Children's Hospital of Philadelphia, states, "Our study supports the notion that maternal psychological support is an important intervention that may someday accompany prenatal diagnosis of CHD, in order to potentially improve outcomes for both fetus and mother."

Dr. Rychik and colleagues from The Children's Hospital of Philadelphia assessed women whose fetus had been diagnosed with serious CHD, requiring newborn assessment and cardiac surgery or catheterization within 6 months after birth. Two to four weeks after initial diagnosis, the researchers surveyed 59 pregnant mothers, ranging in gestational age from 17 to 31.5 weeks, who were recruited by nurse coordinators at either the initial visit to the Fetal Heart Program or a follow-up visit, then followed throughout the rest of their gestation. Participants intended to continue the pregnancy, and to plan for follow-up with the Fetal Heart Program. All were carrying fetuses with serious CHD requiring neonatal evaluation and postnatal surgical or catheter-based intervention within the first six months of life.

Using psychological evaluation tools and self-report instruments, the study team measured traumatic stress, depression and anxiety among the mothers. The researchers also measured partner satisfaction and collected demographic data.

More than 39 percent of the women experienced clinically important traumatic stress, 22 percent experienced depression, and 31 percent experienced state anxiety. Lower partner satisfaction and lower income were both associated with higher levels of depression, anxiety and traumatic stress. When the researchers controlled for partner satisfaction and income, they found denial to be most important factor contributing to depression.  Alternatively, increased acceptance was associated with decreased maternal depression.

Women may grieve the loss of a "normal" pregnancy by going through the various stages of grief (denial, guilt, anger, bargaining, and potentially acceptance). Health care providers should incorporate a strategy of maternal stress reduction through the promotion of coping skills after diagnosis of a fetus with CHD and throughout the pregnancy. Although maternal coping is important, partner satisfaction may be a better "buffer" for the stress of prenatal CHD. Brief couples therapy also may be beneficial to the pregnant women and their partners.

Dr. Rychik's co-authors are Denise D. Donaghue, RN, MSN; Suzanne Levy, Ph.D.; Clara Fajardo, MS; Jill Combs, RN, MSN; Xuemei Zhang, MS; Anita Szwast, M.D., and Guy S. Diamond, Ph.D., all from The Children's Hospital of Philadelphia.

Dr. Rychik is supported in part by the Robert and Dolores Harrington Endowed Chair in Pediatric Cardiology.