Nuchal translucency screening and anxiety levels in pregnancy and puerperium.
OBJECTIVE
To compare levels of anxiety and depression during pregnancy and puerperium between women who are offered nuchal translucency (NT) screening routinely and those who are not, and to compare levels between women accepting and those declining screening.


METHODS
In 12 midwife practices in three different health districts an experimental NT screening program was offered to pregnant women between 1 June 1999 and 1 January 2001. As part of this implementation study, questionnaires including the Hospital Anxiety and Depression Scale (HADS) were completed: after the patient was informed but before screening (T1), at 20 weeks of gestation (T2), and 6 weeks after delivery (T3). A control group of women receiving routine prenatal care (i.e. no screening offered) also completed the HADS questionnaire at 12 and 20 weeks and after delivery.


RESULTS
Five hundred and twenty-seven questionnaires were analyzed. There was a screening uptake of 87% in the intervention group (i.e. those offered screening). Women in this group differed significantly in the percentage of previous miscarriages and religious background compared with the control group. We adjusted for these differences in the analysis. There were no significant differences in HADS scores between the intervention and the control groups at T1, suggesting that women receiving information on screening were not more anxious compared with women who were not informed. Women who were offered screening (acceptors as well as decliners) had significantly lower HADS levels at 20 weeks and after delivery. There were no demographic differences between women accepting and those declining screening.


CONCLUSIONS
Informing women and offering them NT screening for Down syndrome does not increase anxiety or depression levels in pregnancy. In fact, women undergoing or declining screening seem less anxious compared with those who are not offered screening. It is possible that informing women and offering them the chance to decide autonomously whether to participate in screening reduces anxiety levels.
Department of Obstetrics, Academic Medical Center, Amsterdam, The Netherlands. m.a.muller@amc.uva.nl
M A
MA
Müller
O P
OP
Bleker
G J
GJ
Bonsel
C M
CM
Bilardo
D000328:Adult; D001007:Anxiety / Q000209:etiology*; D016022:Case-Control Studies; D003863:Depression / Q000209:etiology*; D004314:Down Syndrome / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands; D048208:Nuchal Translucency Measurement / Q000523:psychology*; D010349:Patient Compliance; D010353:Patient Education as Topic; D018579:Patient Selection; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric