Volume 21, Issue 3 (10-2024)
J Res Dev Nurs Midw 2024, 21(3): 21-25 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Zeidabadi B, Iranpour A, Alavi-Arjas F, Baneshi M R, Shamsadini Moghadam S, Moqaddasi Amiri M et al . Maternal stress in the fetal anomaly screening process: A prospective cohort study. J Res Dev Nurs Midw 2024; 21 (3) :21-25
URL: http://nmj.goums.ac.ir/article-1-1770-en.html
URL: http://nmj.goums.ac.ir/article-1-1770-en.html
Batool Zeidabadi1 
, Abedin Iranpour2 , Fatemeh Alavi-Arjas 3, Mohammad Reza Baneshi4 , Salman Shamsadini Moghadam2 , Mohammd Moqaddasi Amiri5 , Mahdiye Taheri6
, Abedin Iranpour2 , Fatemeh Alavi-Arjas 3, Mohammad Reza Baneshi4 , Salman Shamsadini Moghadam2 , Mohammd Moqaddasi Amiri5 , Mahdiye Taheri6
1- Department of Health Education and Promotion, Sirjan School of Medical Sciences, Sirjan, Iran
2- Department of Health Education and Promotion, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
3- Department of Midwifery, Sirjan School of Medical Sciences, Sirjan, Iran ,f.alaviarjas@gmail.com
4- Australian Women and Girls’ Health Research (AWaGHR) Centre, School of Public Health, The University of Queensland, Brisbane, Australia
5- Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
6- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Department of Health Education and Promotion, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
3- Department of Midwifery, Sirjan School of Medical Sciences, Sirjan, Iran ,
4- Australian Women and Girls’ Health Research (AWaGHR) Centre, School of Public Health, The University of Queensland, Brisbane, Australia
5- Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
6- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: (410 Views)
Background: Fetal health and pregnancy outcomes are significant contributors to increased prenatal stress. The effect of fetal anomaly screening on a mother’s stress is controversial. The present study aimed to explore maternal stress throughout a multi-stage anomaly screening program among healthy pregnant women.
Methods: This prospective cohort study was conducted at the public health centers of Sirjan, Iran from March 2022 to January 2023 using the convenience sampling process. The population included 228 healthy pregnant women. Data were collected using a researcher-made checklist for demographic and obstetrics characteristics. Cohen's Perceived Stress Scale (PSS) was utilized to measure maternal stress at three distinct intervals, including before (weeks 6-10 of pregnancy), during (weeks 11-14 of pregnancy), and after fetal anomaly screening tests (weeks 15-20 of pregnancy). Friedman test was used for measuring the association between maternal stress and fetal abnormality test results. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software version 26 at a significance level of 0.05.
Results: The mothers with higher educational levels (p =0.05, β=1.74), and having a live child experienced lower levels of initial stress (p =0.016, β=2.27). Throughout the time, receiving a normal nuchal translucency (NT) result was associated with a significant decrease in perceived mother's stress (p <0.0001), and abnormal NT ultrasound results (reported in 3.8% of women) led to a rise in the downslope of stress in the third measurement; however, it was not significant.
Conclusion: The present study revealed that maternal stress decreased over time following normal results of fetal anomaly screening. Three factors were associated with lower maternal stress, including university education, having at least a living child, and a normal ultrasound result. Moreover, women at first pregnancy and/or with an abnormal ultrasound result experienced high-stress levels. The findings may be useful in guiding the formulation of health policies and the distribution of resources.
Methods: This prospective cohort study was conducted at the public health centers of Sirjan, Iran from March 2022 to January 2023 using the convenience sampling process. The population included 228 healthy pregnant women. Data were collected using a researcher-made checklist for demographic and obstetrics characteristics. Cohen's Perceived Stress Scale (PSS) was utilized to measure maternal stress at three distinct intervals, including before (weeks 6-10 of pregnancy), during (weeks 11-14 of pregnancy), and after fetal anomaly screening tests (weeks 15-20 of pregnancy). Friedman test was used for measuring the association between maternal stress and fetal abnormality test results. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software version 26 at a significance level of 0.05.
Results: The mothers with higher educational levels (p =0.05, β=1.74), and having a live child experienced lower levels of initial stress (p =0.016, β=2.27). Throughout the time, receiving a normal nuchal translucency (NT) result was associated with a significant decrease in perceived mother's stress (p <0.0001), and abnormal NT ultrasound results (reported in 3.8% of women) led to a rise in the downslope of stress in the third measurement; however, it was not significant.
Conclusion: The present study revealed that maternal stress decreased over time following normal results of fetal anomaly screening. Three factors were associated with lower maternal stress, including university education, having at least a living child, and a normal ultrasound result. Moreover, women at first pregnancy and/or with an abnormal ultrasound result experienced high-stress levels. The findings may be useful in guiding the formulation of health policies and the distribution of resources.
Type of study: Original Article |
Subject:
Midwifery
References
1. Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020;2(4):100229. [View at Publisher] [DOI] [PMID] [Google Scholar]
2. Gokoel AR, Abdoel Wahid F, Zijlmans WCWR, Shankar A, Hindori-Mohangoo AD, Covert HH, et al. Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study. Reprod Health. 2021;18(1):136. [View at Publisher] [DOI] [PMID] [Google Scholar]
3. Stylianou-Riga P, Kouis P, Kinni P, Rigas A, Papadouri T, Yiallouros PK, et al. Maternal socioeconomic factors and the risk of premature birth and low birth weight in Cyprus: a case-control study. Reprod Health. 2018;15(1):157. [View at Publisher] [DOI] [PMID] [Google Scholar]
4. Van den Bergh BR, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev. 2020;117:26-64. [View at Publisher] [DOI] [PMID] [Google Scholar]
5. Gaml-Sørensen A, Brix N, Henriksen TB, Ramlau-Hansen CH. Maternal stress in pregnancy and pubertal timing in girls and boys: A cohort study. Fertil Steril. 2024;122(4):715-26. [View at Publisher] [DOI] [PMID] [Google Scholar]
6. Ramos BA, Formiga CKMR, Oliveira NRGd, Marçal PGE, Ferreira RG, Saidah TK, et al. Relationship between Maternal Stress and Neurobehavioral Indicators of Preterm Infants in the Neonatal Intensive Care Unit. Children. 2024;11(8):889. [View at Publisher] [DOI] [PMID] [Google Scholar]
7. Miltoft CB, Rode L, Ekelund CK, Sundberg K, Kjærgaard S, Zingenberg H, et al. Contingent first‐trimester screening for aneuploidies with cell‐free DNA in a Danish clinical setting. Ultrasound Obstet Gynecol. 2018;51(4):470-9. [View at Publisher] [DOI] [PMID] [Google Scholar]
8. Bekkhus M, Oftedal A, Braithwaite E, Haugen G, Kaasen A. Paternal psychological stress after detection of fetal anomaly during pregnancy. A prospective longitudinal observational study. Front Psychol. 2020;11:1848. [View at Publisher] [DOI] [PMID] [Google Scholar]
9. Khakbazan Z, Farnam F, Abdollahi P, Arjmandifar M. Women's Concerns and Experiences of Fetal Anomaly Screening Process: A Qualitative Study. Int J Community Based Nurs Midwifery. 2023;11(1):44-56. [View at Publisher] [DOI] [PMID] [Google Scholar]
10. Howie C. Down's syndrome screening and reproductive politics: care, choice and disability in the prenatal clinic. J Reprod Infant Psychol. 2019;37(5):566-7. [View at Publisher] [DOI] [Google Scholar]
11. Viotti M. Preimplantation genetic testing for chromosomal abnormalities: aneuploidy, mosaicism, and structural rearrangements. Genes. 2020;11(6):602. [View at Publisher] [DOI] [Google Scholar]
12. Ozyuncu O, Tanacan A, Fadiloglu E, Unal C, Ziyadova G, Deren O. Impact of increased nuchal translucency values on pregnancy outcomes: a tertiary center experience. Fetal Pediatr Pathol. 2021;40(3):189-97. [View at Publisher] [DOI] [PMID] [Google Scholar]
13. Tekesin I. Pregnancy outcome in foetuses with increased nuchal translucency-10-years' experience in a prenatal medical practice. J Obstet Gynaecol. 2020;40(4):455-60. [View at Publisher] [DOI] [PMID] [Google Scholar]
14. Reimers R, High F, Kremen J, Wilkins‐Haug L. Prenatal diagnosis of sex chromosome aneuploidy-What do we tell the prospective parents? Prenat Diagn. 2023;43(2):250-60. [View at Publisher] [DOI] [PMID] [Google Scholar]
15. Arjunan S, Thomas MC. A review of ultrasound imaging techniques for the detection of down syndrome. IRBM. 2020;41(2):115-23. [View at Publisher] [DOI] [Google Scholar]
16. Di Girolamo R, Rizzo G, Khalil A, Alameddine S, Lisi G, Liberati M, et al. Whole exome sequencing in fetuses with isolated increased nuchal translucency: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2023;36(1):2193285. [View at Publisher] [DOI] [PMID] [Google Scholar]
17. Kagan KO, Sonek J, Kozlowski P. Antenatal screening for chromosomal abnormalities. Arch Gynecol Obstet. 2022;305(4):825-35. [View at Publisher] [DOI] [PMID] [Google Scholar]
18. Santorum M, Wright D, Syngelaki A, Karagioti N, Nicolaides KH. Accuracy of first‐trimester combined test in screening for trisomies 21, 18 and 13. Ultrasound Obstet Gynecol. 2017;49(6):714-20. [View at Publisher] [DOI] [PMID] [Google Scholar]
19. Okoror CEM, Arora S. Prenatal diagnosis after high chance non-invasive prenatal testing for trisomies 21, 18 and 13, chorionic villus sampling or amniocentesis?-Experience at a district general hospital in the United Kingdom. Eur J Obstet Gynecol Reprod Biol X. 2023;19:100211. [View at Publisher] [DOI] [PMID] [Google Scholar]
20. Graf WD, Cohen BH, Kalsner L, Pearl PL, Sarnat HB, Epstein LG, et al. Fetal anomaly diagnosis and termination of pregnancy. Dev Med Child Neurol. 2023;65(7):900-7. [View at Publisher] [DOI] [PMID] [Google Scholar]
21. Di Mascio D, Khalil A, Rizzo G, Buca D, Liberati M, Martellucci CA, et al. Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2020;56(5):647-55. [View at Publisher] [DOI] [PMID] [Google Scholar]
22. Monni G, Corda V, Iuculano A, Afshar Y. The decline of amniocentesis and the increase of chorionic villus sampling in modern perinatal medicine. Journal of Perinatal Medicine. 2020;48(4):307-12. [View at Publisher] [DOI] [PMID] [Google Scholar]
23. Marc-Aurele KL. Decisions parents make when faced with potentially life-limiting fetal diagnoses and the importance of perinatal palliative care. Front Pediatr. 2020;8:574556. [View at Publisher] [DOI] [PMID] [Google Scholar]
24. Jeličić L, Veselinović A, Ćirović M, Jakovljević V, Raičević S, Subotić M. Maternal Distress during Pregnancy and the Postpartum Period: Underlying Mechanisms and Child's Developmental Outcomes-A Narrative Review. Int J Mol Sci. 2022;23(22):13932. [View at Publisher] [DOI] [PMID] [Google Scholar]
25. Karimi N, Bahadori F, Khalkhali HR, Rabiepoor S. Evaluation of anxiety and perceived stress in mothers undergoing amniocentesis. Nursing And Midwifery Journal. 2017;15(4):292-300. [View at Publisher] [Google Scholar]
26. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96. [View at Publisher] [DOI] [PMID] [Google Scholar]
27. Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health. 2005;50(4):e36-40. [View at Publisher] [DOI] [PMID] [Google Scholar]
28. Maroufizadeh S, Zareiyan A, Sigari N. Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with asthma. Arch Iran Med. 2014;17(5):361-5. [View at Publisher] [PMID] [Google Scholar]
29. Racine N, Plamondon A, Hentges R, Tough S, Madigan S. Dynamic and bidirectional associations between maternal stress, anxiety, and social support: The critical role of partner and family support. J Affect Disord. 2019;252:19-24. [View at Publisher] [DOI] [PMID] [Google Scholar]
30. Preis H, Somers J, Mahaffey B, Lobel M. When pregnancy and pandemic coincide: changes in stress and anxiety over the course of pregnancy. J Reprod Infant Psychol. 2024;42(3):395-409. [View at Publisher] [DOI] [PMID] [Google Scholar]
31. Cortes Hidalgo AP, Neumann A, Bakermans‐Kranenburg MJ, Jaddoe VW, Rijlaarsdam J, Verhulst FC, et al. Prenatal maternal stress and child IQ. Child Dev. 2020;91(2):347-65. [View at Publisher] [DOI] [PMID] [Google Scholar]
32. Tang X, Lu Z, Hu D, Zhong X. Influencing factors for prenatal stress, anxiety and depression in early pregnancy among women in Chongqing, China. J Affect Disord. 2019;253:292-302. [View at Publisher] [DOI] [PMID] [Google Scholar]
33. Kaasen A, Helbig A, Malt UF, Næs T, Skari H, Haugen G. Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study. PLoS One. 2017;12(3):e0174412. [View at Publisher] [DOI] [PMID] [Google Scholar]
34. Harris JM, Franck L, Michie S. Assessing the psychological effects of prenatal screening tests for maternal and foetal conditions: a systematic review. J Reprod Infant Psychol. 2012;30(3):222-46. [View at Publisher] [DOI] [Google Scholar]
35. Vatankhah S, Jalilvand M, Sarkhosh S, Azarmi M, Mohseni M. Prevalence of Congenital Anomalies in Iran: A Review Article. Iran J Public Health. 2017;46(6):733-43. [View at Publisher] [PMID] [Google Scholar]
36. Irani M, Khadivzadeh T, Asghari Nekah SM, Ebrahimipour H, Tara F. The prevalence of congenital anomalies in Iran: A Systematic Review and Meta-analysis. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;21(Supple):29-41. [View at Publisher] [DOI] [Google Scholar]
37. Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry. 2018;5(4):357-69. [View at Publisher] [DOI] [PMID] [Google Scholar]
38. Wang W, Wen L, Zhang Y, Wang L, Wang L, Chen Z, et al. Maternal prenatal stress and its effects on primary pregnancy outcomes in twin pregnancies. J Psychosom Obstet Gynaecol. 2020;41(3):198-204. [View at Publisher] [DOI] [PMID] [Google Scholar]
39. Tanhae Reshvanloo F, Tavasoli Z, Talepasand S. The role of mothers' awareness about infants care in stress and anxiety during pregnancy: an invariance based on educational level. Zanko J Med Sci. 2018;18(59):80-91. [View at Publisher] [Google Scholar]
40. Mokhtari Zanjani P, Tehranian N, Changizi N, Mohammadi E, Farzinrad B, Kazemnejad A. Maternal mental health concerns during the COVID-19 pandemic in Iran: a content analysis study. Reprod Health. 2023;20(1):102. [View at Publisher] [DOI] [PMID] [Google Scholar]
41. Kim Y, Chung CW. Development of the Korean pregnancy stress scale. Jpn J Nurs Sci. 2018;15(2):113-24. [View at Publisher] [DOI] [PMID] [Google Scholar]
42. Shapiro GD, Séguin JR, Muckle G, Monnier P, Fraser WD. Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort. J Psychosom Obstet Gynaecol. 2017;38(2):121-32. [View at Publisher] [DOI] [PMID] [Google Scholar]
43. Riquelme-Gallego B, Martínez-Vázquez S, Caparros-Gonzalez RA. Pandemic-related stress in pregnant women during the first COVID-19 lockdown and neonatal development. J Reprod Infant Psychol. 2023:1-16. [View at Publisher] [DOI] [PMID] [Google Scholar]
44. Kashanian M, Faghankhani M, YousefzadehRoshan M, EhsaniPour M, Sheikhansari N. Woman's perceived stress during pregnancy; stressors and pregnancy adverse outcomes. J Matern Fetal Neonatal Med. 2021;34(2):207-15. [View at Publisher] [DOI] [PMID] [Google Scholar]
45. Rabipoor S, Abedi M. Perceived Stress and Prenatal Distress during Pregnancy and its Related Factors. J Res Dev Nurs Midw. 2020;17(1):67-80. [View at Publisher] [DOI] [Google Scholar]
46. Bani S, Hasanpour S, Farzadi L, Mirghafourvand M, Golshani F, Ranjbar M. Self-Care Performance of Pregnant Women in Preventing COVID-19 Infection and Its Relationship with Perceived Stress. Iran J Psychiatry. 2023;18(1):26-34. [View at Publisher] [DOI] [PMID] [Google Scholar]
47. Zareipour M, Sadeghianifar A, Amirzehni J, Parsnezhad M, Ayuoghi Rahnema V. Exploring of depression, anxiety and stress in pregnant women referred to health centers of Urmia. Rahavard Salamat Journal. 2017;3(2):19-30. [View at Publisher] [Google Scholar]
48. Rastegari L, Mossayebnezhad R, Hosseinkhani A, Arsang-Jang S. Perceived Stress and Social Support in Pregnant Women during the COVID-19 Pandemic. Nursing and Midwifery Studies. 2023;12(1):42-7. [View at Publisher] [DOI] [Google Scholar]
49. Wheeler JM, Misra DP, Giurgescu C. Stress and coping among pregnant black women during the COVID‐19 pandemic. Public Health Nursing. 2021;38(4):596-602. [View at Publisher] [DOI] [PMID] [Google Scholar]
50. Otu A, Yaya S. Uncovering the collateral impacts of COVID-19 on maternal mental health. Reprod Health. 2022;19(1):115. [View at Publisher] [DOI] [PMID] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
