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.

"Receiving the news of carrying a fetus with a CHD is a stressful event which can potentially influence a mother's anxiety level," said study leader Jack Rychik, M.D., medical director of the Fetal Heart Program in the Cardiac Center at The Children's Hospital of Philadelphia. "Prenatal diagnosis is helpful in that it gives parents time to learn about the defect, review treatment options, plan for necessary interventions and consider their options. While this is intrinsically a stressful time for parents, there has previously been little research on the details of this stress and ways to buffer it."

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.

"Prenatal diagnosis of CHD is a traumatic event for many pregnant women. In our study we found that a substantial proportion of mothers exhibited evidence for traumatic stress, with nearly 40 percent exceeding clinical cut-off points for post-traumatic stress disorder," said Guy S. Diamond, Ph.D., a psychologist at The Children's Hospital of Philadelphia who participated in this study.

"While individual coping skills are important, partner satisfaction may better predict a more resilient response to the stress of prenatal CHD," Diamond added. We have identified 'denial' as an important contributor to depression and that on-going counseling sessions should focus on this risk factor."

"This study is the beginning, and more research needs to be done to ensure we are giving mothers the very best multidisciplinary care. In one way, the families are fortunate to know in advance that their baby has a CHD and in another way given more stress with that knowledge. In the future, optimal management strategies to improve outcomes for both mom and fetus will include stress reduction techniques, which should accompany the diagnosis of CHD prior to birth," added Rychik.

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.