Addressing Perinatal Mental Health Risk within a Fetal Care Center

Dempsey, Allison G.; Chavis, Lacy; Willis, Tiffany; Zuk, Jeannie; Cole, Joanna C.M.

doi:10.1007/s10880-020-09728-2

Cited by 17 publications

(14 citation statements)

References 85 publications

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“…These findings provide evidence that further exploration of the value of an on-staff psychologist to families during the time of their surgery would be beneficial. Previous research has discussed the benefit that a multidisciplinary team provides to patients facing surgical decisions and our study supports this by providing a foundation for further exploration of the benefits of adding psychological services to the team 15. Future studies on patients who undergo MMC repair should seek to determine what factors are emphasized in the counseling of patients by their providers.…”

supporting

confidence: 65%

Factors impacting surgical decision making between prenatal and postnatal repair for myelomeningocele

Fabelo

Lim

et al. 2021

Prenatal Diagnosis

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Objectives: To determine factors influencing patients to choose prenatal or postnatal repair of their child's myelomeningocele (MMC) when both treatment options are offered. Methods:We distributed a retrospective survey via email and social media to parents of children with MMC who were offered both prenatal and postnatal surgery as intervention options.Results: A total of 127 surveys met all inclusion criteria. The majority of responders considered partner's opinion (85%), maternal risks of prenatal surgery (71%), and risk for preterm labor (76%) as influencers. Financially, the costs of childcare (39.4% postnatal, 13.8% prenatal, p = 0.002), relocation (57.6% postnatal, 36.2% prenatal, p = 0.019), and travel (51.5% postnatal, 33% prenatal, p = 0.033) were more influential for the postnatal group while insurance coverage (36.4% postnatal, 68.1% prenatal, p = 0.003) was more influential to the prenatal group. Of the medical factors, the consideration of maternal risk for transfusion was different between surgical groups (39.4% postnatal, 18.1% prenatal, p = 0.015). The open responses suggest that both surgical groups found the quality of life for the baby to be significant to their decision-making.Conclusions: These findings should guide providers to tailor counseling to patient's needs. Comprehensive counseling should include information on financial resources, referral to financial counselors, and psychosocial support services. Key pointsWhat is already known about this topic? � Prenatal surgery to repair myelomeningocele has improved outcomes for children based on results of the 2011 MOMs trial � Although prenatal surgery is associated with improved outcomes for the fetus some patients still opt for a postnatal repair when eligible for a prenatal repair � Patients face considerable challenges when making surgical decisions including familial influences, social influences, and financial influences

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supporting

confidence: 65%

Factors impacting surgical decision making between prenatal and postnatal repair for myelomeningocele

Fabelo

Lim

et al. 2021

Prenatal Diagnosis

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“…Receiving news about a possible or confirmed fetal anomaly is acutely distressing for parents 49–51 . Parents benefit greatly from timely access to information, support and multidisciplinary care when faced with an uncertain prognosis in their pregnancy 49,52 . Information provision of itself is not sufficient for parents to feel supported during the often months‐long journey of uncertainty during the pregnancy.…”

Section: Managing Uncertainty and Supporting Decision‐makingmentioning

confidence: 99%

“…Supportive decision‐making should be nondirective in terms of the decision itself, but directive in terms of guiding parents through the diagnostic journey 49 . Some parents may benefit from referral to specialist perinatal mental health services, particularly in context of previous mental health issues or persistent distress 52 …”

Section: Managing Uncertainty and Supporting Decision‐makingmentioning

confidence: 99%

Increased nuchal translucency after low‐risk noninvasive prenatal testing: What should we tell prospective parents?

et al. 2021

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Three decades ago, the observation that first trimester fetuses with excess fluid accumulation at the back of the neck were more likely to be aneuploid, gave rise to a new era of prenatal screening. The nuchal translucency (NT) measurement in combination with serum biomarkers and maternal age, resulted in the first trimester combined screening (FTCS) program. The introduction of noninvasive prenatal testing (NIPT) over the past decade has introduced the option for parents to receive highly sensitive and specific screening information for common trisomy from as early as 10 weeks gestation, altering the traditional pathway FTCS pathway. The retention of the 11–13‐week NT ultrasound remains important in the detection of structural anomalies; however, the optimal management of pregnancies with a low‐risk NIPT result and an isolated increased NT measurement in an era of advanced genomic testing options is a new dilemma for clinicians. For parents, the prolonged period between the initial diagnosis in first trimester, and prognostic information at each successive stage of investigations up to 22–24 weeks, can be emotionally challenging. This article addresses the common questions from parents and clinicians as they navigate the uncertainty of having a fetus diagnosed with an increased NT after a low‐risk NIPT result and presents suggested approaches to management.

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“…Results support the need for an individualized approach to psychosocial intervention. HEARTPrep intervention elements were perceived as relevant to almost all parent participants as they are intended to address common challenges among expectant parents following prenatal diagnosis of a congenital anomaly (eg, self-blame, interpersonal challenges, lack of emotional preparedness) ( 9 ). However, participants reported varying needs regarding intervention timing and duration and the involvement of partners.…”

Section: Discussionmentioning

confidence: 99%

Partnering With Stakeholders to Inform the Co-Design of a Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease

Sood

Gramszlo²,

Ramirez³

et al. 2022

Journal of Patient Experience

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Input from diverse stakeholders is critical to the process of designing healthcare interventions. This study applied a novel mixed-methods, stakeholder-engaged approach to co-design a psychosocial intervention for mothers expecting a baby with congenital heart disease (CHD) and their partners to promote family wellbeing. The research team included parents and clinicians from 8 health systems. Participants were 41 diverse parents of children with prenatally diagnosed CHD across the 8 health systems. Qualitative data were collected through online crowdsourcing and quantitative data were collected through electronic surveys to inform intervention co-design. Phases of intervention co-design were: (I) Engage stakeholders in selection of intervention goals/outcomes; (II) Engage stakeholders in selection of intervention elements; (III) Obtain stakeholder input to increase intervention uptake/utility; (IV) Obtain stakeholder input on aspects of intervention design; and (V) Obtain stakeholder input on selection of outcome measures. Parent participants anticipated the resulting intervention, HEARTPrep, would be acceptable, useful, and feasible for parents expecting a baby with CHD. This model of intervention co-design could be used for the development of healthcare interventions across chronic diseases.

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Addressing Perinatal Mental Health Risk within a Fetal Care Center

Cited by 17 publications

References 85 publications

Factors impacting surgical decision making between prenatal and postnatal repair for myelomeningocele

Factors impacting surgical decision making between prenatal and postnatal repair for myelomeningocele

Increased nuchal translucency after low‐risk noninvasive prenatal testing: What should we tell prospective parents?

Partnering With Stakeholders to Inform the Co-Design of a Psychosocial Intervention for Prenatally Diagnosed Congenital Heart Disease

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