S. C. Mehl1,2, P. Powell1,2, S. Peiffer1,2, T. Haltom1, T. Lee1,2, S. Keswani1,2, A. King1,2 1Baylor College Of Medicine, Surgery, Houston, TX, USA 2Texas Children’s Hospital, Pediatric Surgeryric Surgery, Houston, TX, USA
Introduction: Following diagnosis of a fetal surgical anomaly, prenatal counseling with shared-decision making occurs with complex discussions regarding prenatal interventions, perinatal surgery, and prognosis. An essential component of decision making is patient empowerment; a metric quantifying the ability of patients to gain control over medical decisions. Expectantly, these counseling sessions can also be associated with significant anxiety. The purpose of this study is to evaluate the association between maternal anxiety and empowerment in this population, and to understand the different aspects of fetal surgical anomalies that impact anxiety.
Methods: A mixed methods study was completed for expectant mothers evaluated at a large tertiary fetal center. Surveys were administered from 5/2021–5/2022 to quantify maternal anxiety (State Trait Anxiety Inventory–State [STAI–State]) and empowerment (Pregnancy Related Empowerment Scale [PRES], Patient Empowerment Scale [PES]). Patients were stratified as having low or high maternal anxiety based on the median survey score for STAI–State. Wilcoxon Rank-Sum was used to compare empowerment scores between mothers with low and high anxiety; significance was defined as p<0.05. Eighteen semi-structured interviews were conducted from 8/2021–12/2021 to explore maternal anxiety relative to the fetal anomaly. Line-by-line coding and thematic analysis was performed to develop emerging themes.
Results: Eighty-one patients completed surveys. The median maternal age and gestational age at the time of survey was 30 years (interquartile range [IQR] 24–34) and 27 weeks (IQR 23–32), respectively. The most common fetal diagnoses were neural tube defect (n=24, 30%), congenital lung malformation (n=18, 22%), and congenital diaphragmatic hernia (n=13, 16%). PRES (high anxiety 58 [IQR 50–60], low anxiety 61 [IQR 54–62]; p=0.04) and PES (high anxiety 52 [IQR 48–56], low anxiety 56 [IQR 53–61]; p<0.01) were significantly lower for expectant mothers with high anxiety. In qualitative interviews, patients described specific psychological stressors related to the diagnosis, including unknowns related to prenatal care through pregnancy, immediate perinatal care (i.e., neonatal intensive care unit and surgery), and long-term prognosis. Mothers described several support systems that helped them navigate these stressors, including fetal nurse coordinators, mothers with similar diagnoses, and extended family.
Conclusion: Our preliminary results suggest there is an association between increased anxiety and decreased empowerment; a metric previously linked to improved maternal-fetal outcomes. Through qualitative analysis, specific stressors and support systems to relieve these stressors were identified. These findings can inform targeted interventions to improve psychosocial support during prenatal counseling to decrease maternal anxiety and potentially improve empowerment.