Maternal Depressive Risk in Prenatal versus Postnatal Surgical Closure of Myelomeningocele: Associations with Parenting Stress and Child Outcomes.

INTRODUCTION: Depressive risk is higher for mothers of infants with chronic medical conditions. The present study examined maternal depressive risk and associations with parent and child outcomes among mothers of young children who were randomized to either prenatal or postnatal surgical closure for myelomeningocele. METHODS: Using the Management of Myelomeningocele Study database, maternal depressive risk was examined at 3 time points as follows: prior to birth, 12 months, and 30 months post birth. Separate multivariate analyses examined associations among change in depressive risk (between baseline and 30 months), parenting stress, and child outcomes at 30 months. RESULTS: Mean scores were in the minimal depressive risk range at all the time points. Post birth depressive risk did not differ by prenatal versus postnatal surgery. Mean change scores reflected a decrease in depressive risk during the first 30 months. Only 1.1-4.5% of mothers reported depressive risk in the moderate to severe range across time points. Increased depressive risk during the first 30 months was associated with increased parenting stress scores and slightly lower child cognitive scores at 30 months. CONCLUSION: Most mothers reported minimal depressive risk that decreased over time, regardless of whether their infant underwent prenatal or postnatal surgery. Only a small percentage of mothers endorsed moderate to severe depressive risk, but an increase in depressive risk over time was associated with higher parental stress and slightly lower child cognitive development.

The rise of tele-mental health in perinatal settings.

We discuss the use of tele-mental health in settings serving expectant parents in fetal care centers and parents with children receiving treatment in neonatal intensive care units within a pediatric institution. Our emphasis is on the dramatic rise of tele-mental health service delivery for this population in the wake of the onset of the COVID-19 pandemic in the U.S., including relevant practice regulations, challenges and advantages associated with the transition to tele-mental health in these perinatal settings.

Addressing Perinatal Mental Health Risk within a Fetal Care Center.

Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.

The impact of our images: psychological implications in expectant parents after a prenatal diagnosis.

Parents are at heightened risk for perinatal depression, anxiety and traumatic stress after receiving a prenatal diagnosis of a congenital anomaly. Identifying patients at risk and implementing effective support is crucial to optimizing care in this vulnerable population. A multidisciplinary care team with embedded psychosocial support services can be utilized to evaluate and address the needs of pregnant women and their families, not only at the time of diagnosis, but throughout the course of the pregnancy and postpartum period. Provider awareness helps to facilitate expedited referral to psychosocial services to provide comprehensive care to the patient and family unit.

Developing an Infrastructure for Bereavement Outreach in a Maternal-Fetal Care Center.

Although bereavement programs are a common element of palliative medicine and hospice programs, few maternal-fetal care centers offer universal bereavement outreach services following perinatal loss. In this article, we describe the implementation of a bereavement outreach program at the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia. The four primary goals identified when developing the bereavement outreach protocol included: (1) centralize communication for patient tracking when a perinatal loss occurs, (2) provide individualized and consistent resource support for grieving patients and families, (3) identify strategic outreach points throughout the first year post-loss, and (4) instate programmatic improvements in response to feedback from patients and their families. Strategies for establishing standardized follow-up protocols and operationalizing methods to address outreach initiatives will be shared, with the primary aim of providing other fetal care centers with a proposed model for perinatal bereavement outreach services.

Facilitating Milk Donation in the Context of Perinatal Palliative Care.

The option to donate milk within the context of perinatal palliative care allows pregnant women to be involved in medical decision making before birth. In this article we examine how a perinatal bereavement program engages women and families in the process of milk donation when the deaths of their newborns are anticipated. We include two case examples to offer insight into the complexities within the patient experience of milk donation after perinatal loss.

Universal Postpartum Mental Health Screening for Parents of Newborns With Prenatally Diagnosed Birth Defects.

OBJECTIVE: To describe the implementation of a nurse-led project to screen parents for depression and traumatic stress in the postpartum period after visiting their newborns in the NICU. DESIGN: A standardized universal mental health postpartum screening and referral protocol was developed for parents of high-risk neonates. SETTING/LOCAL PROBLEM: The project occurred at the Garbose Family Special Delivery Unit, the world's first obstetrics unit housed within a pediatric hospital serving healthy women who give birth to newborns with prenatally diagnosed fetal anomalies. Parents of neonates admitted to the NICU are at greater risk to develop postpartum psychological distress; therefore, early identification is critical. PATIENTS: A total of 1,327 participants were screened, including 725 women who gave birth to live newborns at the Garbose Family Special Delivery Unit and 602 fathers. INTERVENTION/MEASUREMENTS: Obstetric nurses asked parents to complete a screening tool that assessed their psychological risk in the postpartum period. A system for mental health triage and referral was available for parents with elevated scores. RESULTS: Overall monthly screening procedure compliance rates were high (96.5% mothers and 79.6% fathers). Women (5.5%, n = 40) and men (5.5%, n = 33) showed high risk for traumatic stress, and 35.9% (n = 260) of women and 9.5% (n = 57) of men showed elevated risk for major depression in the imediate postpartum period. CONCLUSION: Incorporating the screening process into routine nursing practice with immediate mental health triage and referral made the program feasible. The risk factors identified add to the growing knowledge about parents of newborns in the NICU.

A Proposed Model for Perinatal Palliative Care.

Perinatal palliative care allows for an active partnership among a pregnant woman, her family, and her multidisciplinary treatment team and addresses her specialized medical care, emotional, social, and familial needs when a life-limiting fetal diagnosis is confirmed. The purpose of this article is to highlight the multidisciplinary care model used within a perinatal palliative care program. A case study provides a unique perspective on support needed for parents who anticipate that their newborn may die before or shortly after birth.

Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality.

The aim of the study was to determine the incidence of psychological distress among expectant women carrying fetuses with prenatal diagnosed abnormalities and their partners. A 2-year retrospective medical chart review was completed of 1032 expectant mothers carrying fetuses with a confirmed anomaly, and 788 expectant fathers, who completed the CFDT Mental Health Screening Tool. Furthermore, 19.3 % of women and 13.1 % of men reported significant post-traumatic stress symptoms, and 14 % of men and 23 % of women scored positive for a major depressive disorder. Higher risk was noted among expectant parents of younger age and minority racial/ethnic status, and women with post-college level education and current or prior use of antidepressant medications. Heightened distress was noted within fetal diagnostic subgroups including neck masses, sacrococcygeal teratomas, neurological defects, and miscellaneous diagnoses. Incorporating screening tools into prenatal practice can help clinicians better identify the potential risk for psychological distress among expectant parents within high-risk fetal settings.

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital.

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.

Early pregnancy in adolescents: diagnosis, assessment, options counseling, and referral.

Health care providers are faced with many challenges when working with adolescents. Vague symptoms, unreliable menstrual history, and adolescent reluctance to disclose sexual activity present challenges to early diagnosis. When pregnancy is suspected, clinicians need skills for accurate diagnosis, conducting comprehensive assessments, and providing options counseling. Complexities of providing confidential care while balancing the needs of the adolescent and family may deter some clinicians. A clinical case scenario illustrates important elements of care. Through sharing lessons learned from 10 years of working in a Pregnancy Follow-up Clinic, the authors hope to empower other clinicians as they care for adolescents during this critical time.