title: Modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease.
abstract: OBJECTIVE
  Prenatal diagnosis of congenital heart disease (CHD) reportedly increases parental stress compared with postnatal diagnosis. We investigated the association of timing of diagnosis with parental stress and modifiers of this relationship.
  
  
  METHODS
  We enrolled parents with a fetus/infant diagnosed prenatally (Group 1) or postnatally (Group 2) with CHD requiring intervention prior to newborn discharge. Parents completed a Basic Symptom Inventory (BSI) - at diagnosis, birth, and follow-up. Adjusted mixed effects regression models compared scores.
  
  
  RESULTS
  The BSI was completed by 105 families (Group 1, n = 60 and Group 2, n = 45). On regression modeling, anxiety and global stress were lower in Group 1 (effect size -0.19 to -0.62) at diagnosis and birth though not at follow-up. When stratified by gender, Group 1 scores for anxiety and stress were primarily lower in fathers. Within Group 1, mothers scored higher in all domains and later gestational age at diagnosis was associated with higher anxiety and stress.
  
  
  CONCLUSIONS
  Contrary to prior reports, parents of prenatally diagnosed infants with CHD had lower anxiety and stress than those diagnosed postnatally after adjusting for severity. Identifying those most vulnerable and modifiable risk factors will allow us to appropriately target psychosocial services for families with a CHD diagnosis.
authors.affiliation: a Division of Pediatric Cardiology .
authors.forename: Nelangi M
authors.initials: NM
authors.lastname: Pinto
authors.affiliation: b Department of Pediatrics , and.
authors.forename: Cindy
authors.initials: C
authors.lastname: Weng
authors.affiliation: b Department of Pediatrics , and.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.affiliation: a Division of Pediatric Cardiology .
authors.forename: Kimberly
authors.initials: K
authors.lastname: Simon
authors.affiliation: b Department of Pediatrics , and.|c Department of Obstetrics and Gynecology , University of Utah , Salt Lake City , UT , USA.
authors.forename: Janice B
authors.initials: JB
authors.lastname: Byrne
authors.affiliation: a Division of Pediatric Cardiology .
authors.forename: Thomas
authors.initials: T
authors.lastname: Miller
authors.affiliation: a Division of Pediatric Cardiology .
authors.forename: Michael D
authors.initials: MD
authors.lastname: Puchalski
mesh_terms: D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000523:psychology*; D011446:Prospective Studies; D013315:Stress, Psychological; D013997:Time Factors
keywords: Anxiety; congenital heart disease; depression; prenatal diagnosis; ultrasound