Effect of short-term psychological intervention on anxiety of pregnant women with positive screening results for chromosomal disorders: a randomized controlled trial

Abstract

Background and aim Prenatal diagnosis of fetal abnormalities is a critical and stressful event for women. Most pregnant women are concerned about fetal abnormalities and screening tests. Due to the importance of anxiety reduction in pregnant women, this study was conducted to determine the effect of short-term psychological intervention on the anxiety of pregnant women with positive screening results for chromosomal disorders. Methods A randomized clinical trial was performed on women referred to Akbarabadi Hospital in Tehran, Iran, who had positive screening results for chromosomal abnormalities. Participants were selected from eligible individuals by a continuous method and were assigned to two groups of cognitive-behavioral training (n = 46) and control (n = 46), using the block balanced randomization method. Participants in the cognitive-behavioral training group received 4 sessions of individual counseling. The control group received routine pregnancy visits. The Spielberger State-Trait Anxiety Inventory was completed before the intervention and immediately at the end of the intervention (before receiving the amniocentesis result). The analysis of intervention effects was performed as intention-to-treat and per-protocol analysis. Results There was a statistically significant difference in post-intervention state anxiety scores and trait anxiety scores (p < 0.001) between the intervention and control groups, when their means were adjusted for pre-intervention scores for both intention-to-treat and per-protocol analysis. Also, there was a large effect size between the groups in terms of state (ITT: ηp2 = 0.63, PP: ηp2 = 0.71) and trait (ITT: ηp2 = 0.72, PP: ηp2 = 0.75) anxiety scores clinically for both intention-to-treat and per-protocol analysis. The intervention group had a statistically significant and large decrease in state and trait anxiety scores from pretrial to post-trial. In contrast, the control group had a statistically significant and medium increase in state and trait anxiety scores from pretrial to post-trial. Conclusion The results showed that cognitive-behavioral training reduced the anxiety of pregnant women with positive screening results for chromosomal disorders. According to the results, it is recommended to hold cognitive-behavioral training classes to reduce the anxiety of pregnant women with a positive screening result for chromosomal disorders. Trial registration IRCT.ir: IRCT20180427039436N7; date of registration: 24/08/2020 2020-08-24.

The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta‐analysis

“…To investigate the potential impact of outliers, an influence analysis was also conducted. This identified four potential influential outliers (Bayat et al, 2021; Ponting et al, 2022; Shahsavan et al, 2021; Zemestani & Fazeli Nikoo, 2019). When these studies were omitted, the overall effect size was reduced ( d = −0.60) as were the confidence intervals (−0.91 to −0.29), albeit still significant, as well as reduced heterogeneity (87.4%).…”

“…To account for outliers, the above analysis was re‐run with the omission of the Zemestani and Fazeli Nikoo (2019), Shahsavan et al (2021), Bayat et al (2021) and Ponting et al (2022)studies. For group interventions, the overall effect size for the effect of intervention versus control reduced to d = −0.82 (95% CI = −1.33 to −0.23), indicating a medium effect.…”

Prenatal Ultrasound Screening and Women’s Expectations: an Original Study

“…Pregnancy is a time of vulnerability for the woman, enhanced by her fear for the well-being of the baby ( 23 ). So, it is very important to be handled with great care by the healthcare providers (Obstetricians and Midwives) overseeing the health of the mother and her child.…”

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“…While mostly cross-sectional studies were carried out, some described a randomized controlled trial (RCT) [9,23,24] or other longitudinal design [18]. A limited range of instruments was used, some of which were presented in validation papers.…”

“…A causal pathway was evidenced with measures at several time points showing a significant effect on cortisol levels and mood, though not on symptoms of depression [9]. Another RCT involved a short-term psychological intervention, using cognitive behavioural therapy (CBT), resulting in anxiety reduction in pregnant women with positive screening for chromosomal disorders [23]. A significant reduction in pregnancy-related anxiety was demonstrated by Shen et al [24], as well as reduced physical symptoms of anxiety among advanced multiparas, following needs-based education.…”