Child and Adolescent Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris; Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Université de Paris.
Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Université de Paris.
J Gynecol Obstet Hum Reprod. 2022 Apr;51(4):102353. doi: 10.1016/j.jogoh.2022.102353. Epub 2022 Mar 3.
To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality.
Observational study, in a French Tertiary Maternity.
25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS).
Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p = 0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW.
This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.
评估胎儿异常终止妊娠（TOP）后后续妊娠的情绪困扰和产前依恋。
在法国一家三级产科医院进行观察性研究。
25 名年龄在 18 岁及以上的因胎儿异常而接受医学终止妊娠后再次怀孕的妇女。在妊娠 20 周（GW）、27 GW 和 35 GW 时进行产前访谈，以及产后 3 个月和每次自行进行焦虑、创伤后应激综合征（PCLS）抑郁症状（EPDS）、产前依恋（PAI）和围产期悲伤量表（PGS）的问卷调查。
妊娠开始时，即 20 GW 之前，焦虑（16/23，66.7%）、抑郁（7/23，30.4%）和创伤后应激症状（4/16，25%）的患病率较高。PGS 的总评分在妊娠开始时高于妊娠晚期（p=0.005）。早期妊娠时的产前依恋较低（p=0.003），与悲伤强度呈负相关（p=0.022）。在妊娠晚期，情绪症状减轻，产前依恋停止增加，尤其是在先前妊娠中胎儿异常被诊断较晚的妇女中，平均在 25 GW。
这项研究显示了 TOP 后妊娠的特定动态，并强调了早期产前心理支持的必要性。在知道胎儿健康后，还应该特别注意妊娠晚期的产前依恋。
