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Reduction in Maternal Anxiety after Prenatal Urologic Consultations
Zo G. Baker, PhD1, Hannah Dillon, BS1, Arthi Hannallah, MD1, Irene Klecha, RN, MSN1, Jessica Yang, BS2, Joan Ko, MD1, Roger De Filippo, MD1, Evalynn Vasquez, MD, MBA1.
1Children's Hospital Los Angeles, Los Angeles, CA, USA, 2Boston University School of Public Health, Boston, MA, USA.

BACKGROUND: Prenatal imaging allows for early detection of congenital anomalies affecting the kidneys, urinary tract and genitalia. While pregnancy-related stress affects many expectant mothers, abnormal fetal findings may compound anxiety and worry. Maternal stress may also be associated with adverse health events such as premature birth. While most children with urologic anomalies will not require intervention until after birth, prenatal counseling allows providers to determine a predisposed plan for the mother and child, increases communication between urologists and other providers, and may alleviate maternal stress. We aimed to determine whether prenatal pediatric urologic consultation was associated with reductions in self-reported anxiety and worry among women with suspected fetal urologic anomalies. METHODS: Pregnant women with fetuses diagnosed with suspected urologic anomalies and referred to a Fetal Maternal Center for in-person or telehealth prenatal pediatric urologic consultation were prospectively recruited. Study participants completed two questionnaires up to one week before and after prenatal pediatric urologist consultations. Questionnaires included relevant sociodemographic and medical questions, the General Anxiety Disorder 7-item (GAD-7), the State-Trait Anxiety Inventory (STAI), and a Likert scale question assessing worry surrounding their baby's urologic diagnosis. Differences in anxiety and worry before versus after pediatric urology consultation were assessed using paired t-tests and Pearson Chi-Square tests.
RESULTS: Twenty-six pregnant women seen by a pediatric urologist prenatally due to a suspected fetal anomaly completed pre- and post-visit questionnaires. The majority of women (92.3%; n=24) received consultation for potential anomalies of the fetal kidney(s), including hydronephrosis or suspected multicystic dysplastic kidney. Consultations were conducted in-person for 53.8% (n=14) of participants, and via telehealth for the remaining 46.2% (n=12) of participants. Over 80% (n=21) of participants reported using the internet to learn more about the suspected urologic diagnosis prior to pediatric urologist prenatal consultation. After prenatal urology consultation, the proportion of women reporting extreme or moderate worry regarding their baby's urologic diagnosis significantly decreased from 68.0% (n=17) to 28.0% (n=7; p=0.02; Table 1; Figure 1). Similarly, mean state anxiety on the STAI significantly decreased from 35.2 (9.4) to 31.4 (11.1) after prenatal urology consultation (p=0.02; Table 1). The degree of reduction in self-reported worry and anxiety did not significantly differ depending on whether pediatric urologist consultation occurred in-person or via telehealth.
CONCLUSIONS: Prenatal pediatric urologist consultations via in-person visit or telehealth are associated with reduced maternal self-reported anxiety and worry among mothers with suspected fetal urologic anomalies.


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