Indeterminate Prenatal Ultrasounds and Maternal Anxiety: A Prospective Cohort Study

19 Pages Posted: 29 May 2019

See all articles by Marielle S. Gross

Marielle S. Gross

Johns Hopkins Berman Institute of Bioethics

Hyeyoung Ju

Johns Hopkins University - Johns Hopkins Hospital

Lauren M. Osborne

Johns Hopkins University - Johns Hopkins Medical Institutions

Eric Jelin

Johns Hopkins University

Priya Sekar

affiliation not provided to SSRN

Angie C. Jelin

Johns Hopkins University

Date Written: February 23, 2019

Abstract

Introduction: Prenatal ultrasounds often yield indeterminate (incomplete or minor abnormality) findings with limited clinical utility. We evaluate impact of indeterminate findings on maternal anxiety.

Methods: A single-center prospective cohort study administered the Perinatal Anxiety Screening Scale (PASS; control mean=13.4; >20 denotes clinically significant anxiety) before and after prenatal ultrasounds in February-May 2017. Ultrasound reports were coded as: normal; indeterminate; or major abnormality. Primary outcome was anxiety after indeterminate vs. normal ultrasounds. Secondary outcomes included anxiety change from pre-to-post-ultrasound and relative to maternal characteristics. Linear regression adjusted for confounders.

Results: Of 286 ultrasounds, 51.0% were normal, 40.5% indeterminate (22.0% incomplete; 18.5% minor abnormality), and 8.0% major abnormalities. Indeterminate findings were unrelated to age, race, parity, infertility, or psychiatric history, but associated with gestational age (26.6%/45.0%/52.5% for first/second/third trimesters; p<.001), and obesity (48.8% vs. 37.0%; p=.031). Pretest anxiety was highest in second/third trimesters (p=.029), and in subjects aged age ≤24 or younger(p<.001), with a history of anxiety (p<.001),) or with prior pregnancy loss (p=.011). Mean anxiety score decreased pre-to-posttest across all groups. Indeterminate findings were associated with higher PASS scores than normal findings: pretest 20.1 vs. 16.4 (p=.026) and posttest 16.9 vs. 12.2 (p=.009; adjusted-p=.01). Versus normal ultrasounds, incomplete findings were associated with higher post-ultrasound anxiety (p=.007; adjusted-p=.01) and smaller decreases from pre-to-posttest (adjusted-p=.03), whereas minor abnormalities had higher pretest anxiety (p=.029) with larger pre-to-posttest decreases (adjusted-p=.010).

Discussion: Indeterminate ultrasounds, especially incomplete findings, are associated with significantly higher anxiety than normal findings, suggesting need for evidence-based counseling, management and strategies for decreasing number of indeterminate results.

Keywords: prenatal ultrasound, anxiety, indeterminate findings, incomplete ultrasounds, minor abnormalities, isolated soft marker, perinatal mood disorders, follow up ultrasounds, sonogram, perinatal anxiety, first trimester screening, anatomy ultrasound, growth ultrasound, bioethics, ethics

Suggested Citation

Gross, Marielle S. and Ju, Hyeyoung and Osborne, Lauren M. and Jelin, Eric and Sekar, Priya and Jelin, Angie C., Indeterminate Prenatal Ultrasounds and Maternal Anxiety: A Prospective Cohort Study (February 23, 2019). Available at SSRN: https://ssrn.com/abstract=3391002 or http://dx.doi.org/10.2139/ssrn.3391002

Marielle S. Gross (Contact Author)

Johns Hopkins Berman Institute of Bioethics ( email )

1809 Ashland Ave.
Baltimore, MD 21205
United States

Hyeyoung Ju

Johns Hopkins University - Johns Hopkins Hospital ( email )

United States

Lauren M. Osborne

Johns Hopkins University - Johns Hopkins Medical Institutions ( email )

550 N. Broadway
Baltimore, MD 21205
United States

Eric Jelin

Johns Hopkins University ( email )

Baltimore, MD 20036-1984
United States

Priya Sekar

affiliation not provided to SSRN

Angie C. Jelin

Johns Hopkins University ( email )

Baltimore, MD 20036-1984
United States

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