Parental Psychological Distress after Prenatal Diagnosis of Congenital Heart Disease: Patterns, Predictors, and Impact on Early Outcomes.

Congenital heart disease (CHD) is the most common birth defect and is often diagnosed during pregnancy. The transition to parenthood after prenatal diagnosis can be particularly challenging. Both mothers and fathers are at elevated risk for psychological distress, yet early distress frequencies and patterns have not been well characterized. The impact of psychological distress on parents’ perceptions of their readiness to care for their infant after hospital discharge is currently unknown. The association of psychological distress with early infant neurodevelopment has also been under investigated. To examine these gaps in knowledge, we conducted a single center, prospective cohort study of 34 pregnant women and 29 expectant fathers who received a prenatal diagnosis of moderate-severe fetal CHD from June 2018-December 2019. Participants completed self-report questionnaires twice during pregnancy and twice after birth. Symptoms of psychological distress were assessed at all four time points, parental perceptions of readiness for infant hospital discharge were assessed during initial hospitalization after birth, and infant neurodevelopment was assessed at age 3-6 months. Symptoms of psychological distress were present in 38% of mothers and 24% of fathers and occurred across multiple time points. While the rates of psychological distress in mothers and fathers did not differ, mothers appeared to demonstrate a wider range and severity of symptoms. Hierarchical Linear Modeling analysis found no evidence for change in probability of distress over time and no difference in the trajectories of distress between mothers and fathers. However, individual distress trajectories within both groups demonstrated considerable variability. Maternal psychological distress at infant hospital discharge was associated with lower discharge readiness in mothers. Maternal psychological distress was not associated with infant neurodevelopment at age 3-6 months, although there was an association between the infant’s severity of illness and neurodevelopment. The frequency of psychological distress in parents who receive a prenatal CHD diagnosis emphasizes the importance of early and consistent psychological screening. The impact of psychological distress on maternal discharge readiness highlights the need for supportive services prior to infant hospital discharge. Continued research is needed to understand the neurodevelopmental effects of early parental psychological distress in this high-risk population