Maternal posttraumatic stress, depression and anxiety are common after prenatal diagnosis of congenital heart disease, according to a study.

Heart defects are the most common form of congenital malformations affecting newborns, researchers noted in background information for the study, which is scheduled for publication in the Journal of Pediatrics. Infants with a prenatal diagnosis of CHD are more stable and have better outcomes than infants diagnosed after birth, and a prenatal diagnosis allows mothers to educate themselves on malformations, consider their options and potentially plan for intervention or surgery after birth.

However, maternal stress, which may arise from a prenatal diagnosis, has been linked to fetal disturbances in the hypothalamic-adrenal-pituitary system, poor intrauterine growth, preterm birth and small size for gestational age.

A healthy relationship with a spouse or domestic partner and positive coping mechanisms are important for pregnant women to successfully deal with stress, the researchers said. "Our study supports the notion that maternal psychological support is an important intervention that may someday accompany prenatal diagnosis of CHD, in order to potentially improve outcomes for both fetus and mother," Jack Rychik, MD, of the Fetal Heart Program at The Cardiac Center at The Children’s Hospital of Philadelphia, said in a news release.

The researchers assessed women whose fetus had been diagnosed with serious CHD, requiring newborn assessment and cardiac surgery or catheterization within six months after birth. Two to four weeks after initial diagnosis, 59 pregnant women were given self-reporting surveys to assess their perceived posttraumatic stress, anxiety, depression, coping responses and couples/partner adjustment.

Of the survey respondents, 22% had depression, 31% had anxiety and 39% had traumatic stress. Low income was associated with increased maternal depression. Low satisfaction with a spouse or partner was associated with increased maternal depression and anxiety.

Denial was associated with increased maternal depression, anxiety and traumatic stress, regardless of spouse or partner satisfaction or income. Conversely, increased acceptance was associated with decreased maternal depression. The researchers noted that women may cope with a prenatal diagnosis of CHD by going through the various stages of grief (denial, guilt, anger, bargaining and potentially acceptance).

Healthcare providers should incorporate a strategy of maternal stress reduction through the promotion of coping skills after diagnosis of a fetus with CHD and throughout the pregnancy, the researchers said. Although maternal coping is important, partner satisfaction may be a better buffer for the stress of prenatal CHD, they added. Brief couples therapy also may be beneficial to pregnant women and their partners.