Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
Hum Reprod. 2024 Mar 1;39(3):569-577. doi: 10.1093/humrep/dead275.
What factors influence the decision-making process of fathers regarding multifetal pregnancy reduction or maintaining a triplet pregnancy, and how do these decisions impact their psychological well-being?
For fathers, the emotional impact of multifetal pregnancy reduction or caring for triplets is extensive and requires careful consideration.
Multifetal pregnancy reduction is a medical procedure with the purpose to reduce the number of fetuses to improve chances of a healthy outcome for both the remaining fetus(es) and the mother, either for medical reasons or social considerations. Aspects of the decision whether to perform multifetal pregnancy reduction have been rarely investigated, and the impact on fathers is unknown.
STUDY DESIGN, SIZE, DURATION: Qualitative study with semi-structured interviews between October 2021 and February 2023.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Fathers either after multifetal pregnancy reduction from triplet to twin or singleton pregnancy or ongoing triplet pregnancies 1-6 years after the decision were included. The interview schedule was designed to explore key aspects related to (i) the decision-making process whether to perform multifetal pregnancy reduction and (ii) the emotional aspects and psychological impact of the decision. Thematic analysis was used to identify patterns and trends in the father's data. The process involved familiarization with the data, defining and naming themes, and producing a final report. This study was a collaboration between a regional secondary hospital (OLVG) and a tertiary care hospital (Amsterdam University Medical Center, Amsterdam UMC), both situated in Amsterdam, The Netherlands.
Data saturation was achieved after 12 interviews. Five main themes were identified: (i) initial responses and emotional complexity, (ii) experiencing disparities in counselling quality and post-decision care, (iii) personal influences on the decision journey, (iv) navigating parenthood: choices, challenges, and emotional adaptation, and (v) shared wisdom and lessons. For fathers, the decision whether to maintain or reduce a triplet pregnancy is complex, in which medical, psychological but mainly social factors play an important role. In terms of psychological consequences after the decision, this study found that fathers after multifetal pregnancy reduction often struggled with difficult emotions towards the decision; some expressed feelings of doubt or regret and were still processing these emotions. Several fathers after an ongoing triplet had experienced a period of severe stress in the first years after the pregnancy, with major consequences for their mental health. Help in emotional processing was not offered to any of the fathers after the decision or birth.
LIMITATION, REASONS FOR CAUTION: While our study focuses on the multifetal pregnancy reduction process in the Amsterdam region, we recognize the importance of further investigation into how this process may vary across different regions in The Netherlands and internationally. We acknowledge the potential of selection bias, as fathers with more positive experiences might have been more willing to participate. Caution is needed in interpreting the role of the mother in the recruitment process. Additionally, the time span of 1-6 years between the decision and the interviews may have influenced emotional processing and introduced potential reporting bias.
The emotional impact of multifetal pregnancy reduction or caring for triplets is significant, emphasizing the need for awareness among caregivers regarding the emotional challenges faced by fathers. A guided trajectory might optimize the decision-making and primarily facilitate the provision of appropriate care thereafter to optimize outcomes around decisions with potential traumatic implications.
STUDY FUNDING/COMPETING INTEREST(S): This study received no funding. The authors have no conflicts of interest to declare.
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是什么因素影响了父亲在多胎妊娠减少或维持三胞胎妊娠方面的决策过程，这些决策如何影响他们的心理健康？
对于父亲来说，多胎妊娠减少或照顾三胞胎的情感影响是广泛的，需要仔细考虑。
多胎妊娠减少是一种医疗程序，目的是减少胎儿数量，以提高剩余胎儿（们）和母亲的健康结局的机会，无论是出于医疗原因还是社会考虑。关于是否进行多胎妊娠减少的决策的各个方面很少被调查，而且对父亲的影响是未知的。
研究设计、规模、持续时间：2021 年 10 月至 2023 年 2 月进行的定性研究，采用半结构式访谈。
参与者/材料、设置、方法：包括多胎妊娠减少后从三胞胎到双胞胎或单胎妊娠的父亲，或多胎妊娠减少决策后 1-6 年继续三胞胎妊娠的父亲。访谈时间表旨在探讨与（i）是否进行多胎妊娠减少的决策过程相关的关键方面，以及（ii）决策的情感方面和心理影响。采用主题分析来识别父亲数据中的模式和趋势。该过程涉及熟悉数据、定义和命名主题以及生成最终报告。这项研究是由荷兰阿姆斯特丹的一家地区性二级医院（OLVG）和一家三级保健医院（阿姆斯特丹大学医学中心，阿姆斯特丹 UMC）合作进行的。
在进行了 12 次访谈后达到了数据饱和。确定了五个主要主题：（i）最初的反应和情绪复杂性，（ii）经历咨询质量和决策后护理的差异，（iii）个人对决策过程的影响，（iv）为人父母：选择、挑战和情绪适应，以及（v）共同的智慧和经验教训。对于父亲来说，维持或减少三胞胎妊娠的决定是复杂的，其中医疗、心理但主要是社会因素起着重要作用。就决策后的心理后果而言，本研究发现，多胎妊娠减少后的父亲经常对这一决定感到情绪复杂；一些人表达了怀疑或遗憾的感觉，并仍在处理这些情绪。一些继续三胞胎妊娠的父亲在妊娠后的头几年经历了一段严重的压力期，对他们的心理健康产生了重大影响。没有向任何一位决策或生育后的父亲提供情感处理方面的帮助。
局限性、谨慎的原因：虽然我们的研究集中在阿姆斯特丹地区的多胎妊娠减少过程，但我们认识到有必要进一步研究这一过程在荷兰和国际上可能如何因地区而异。我们认识到选择偏差的可能性，因为更积极的经验的父亲可能更愿意参与。在解释母亲在招募过程中的作用时需要谨慎。此外，决策和访谈之间 1-6 年的时间跨度可能会影响情感处理，并引入潜在的报告偏差。
多胎妊娠减少或照顾三胞胎的情感影响是显著的，这强调了护理人员需要意识到父亲所面临的情感挑战。指导轨迹可能会优化决策过程，并主要促进提供适当的护理，以优化具有潜在创伤性影响的决策的结果。
研究资金/利益冲突：本研究没有收到任何资金。作者没有利益冲突需要申报。
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