(P078) PSYCHOLOGICAL IMPACTS OF FETAL ECHOCARDIOGRAPHY REFERRAL AND RESULTS ON THE EXPECTING PARENTS

Background: Guidelines from the American Heart Association (2024) and the American Society of Echocardiography (2023) recommend referral for a FE when a pregnancy is at elevated risk of congenital heart disease (CHD), even in the context of a normal ultrasound (U/S). We have shown that this approach has a low yield of identifying severe CHD. Some have argued that FE and U/S have no side effect, therefore lowering the threshold to perform them. However, referrals to specialized care can increase stress and anxiety for the expecting parents. We assessed whether women referred to a FE despite a normal U/S reported increased anxiety, compared to women without referral.

METHODS AND RESULTS: This was a Canadian multicenter prospective observational cross-sectional study taking place in 6 hospitals in Quebec and Ontario. We enrolled 41 pregnant women who were referred for FE despite normal 2nd trimester ultrasound and compared them to a cohort of 42 pregnant women who were not referred for a FE. The Spielberger State-Trait Anxiety Inventory (STAI) assessed the level of anxiety they are experiencing "now" (state) versus how they "usually feel" (trait). The difference between state score and trait score was compared using non-parametric statistical analysis.

There was no significant age difference between the two groups (30.7 vs. 31.1 years). The control group reported a higher level of education, with 33.7% having a university degree, compared to 28.2% in the FE group. Similarly, the control group reported higher household incomes, with 33.8% earning more than 100.000$/year in the control group, compared to 13.2% in the FE group. The two groups reported similar “trait” scores (how they usually feel): 35.9 for the control group and 34.9 for the FE group. Women in the FE reported a higher difference between the “state” and “trait” score, meaning a higher anxiety state compared to how they usually feel, compared to the control group: the difference was 5.2 points (95% confidence interval: 0.5 to 9.9, p=0.03). After adjustment for confounding, this difference was 5.5 points (95% confidence interval: 0.0 to 11.1, p=0.05).

Conclusion: Our study demonstrated an association between being referred for a FE and a heighten anxiety score, despite no suspicion of a cardiac anomaly at the U/S. This potential adverse effect of being referred should be weighed in when relatively low-risk women are being referred to a FE.