BackgroundAntenatal hydronephrosis (ANH), a condition characterized by dilation of the fetal renal collecting system, impacts 1-4% of pregnancies and may be a significant source of stress and anxiety for expectant mothers. Little is known about the relationships between the diagnosis of ANH and maternal anxiety. The objective of this study was to evaluate maternal stress, anxiety, and coping following a diagnosis of ANH.
MethodsMothers of infants 6 months of age and less who were diagnosed prenatally with mild, moderate, or severe hydronephrosis completed a cross-sectional survey between March-May 2023. We excluded those with additional congenital/genetic abnormalities or diagnosis of posterior urethral valves. The survey included open ended questions, questions regarding anxiety following diagnosis, and the Spielberger State Trait Anxiety Inventory (STAI). The STAI, a validated 40-item measure, differentiates acute state anxiety (STAI-S) and trait anxiety (STAI-T), or an individual’s tendency towards anxiety. Scores range from 20-80 with higher scores indicating greater anxiety. Additional data included prenatal anteroposterior diameter (APD), parity, amniotic fluid index (AFI), postnatal ultrasound findings using the Urinary Tract Dilation (UTD) classification, management recommendations, birth weight and gestational age. Descriptive statistics and bivariate linear regression models were used to analyze quantitative data with p <0.05 designated as statistically significant. Preliminary themes from open-ended questions were identified using thematic analysis.
ResultsTwenty mothers completed the survey. The demographics of mothers are detailed in Table 1. Mothers were primarily married (n=18), White and non-Hispanic (n=17) (Table 1). Immediately following diagnosis, 60% (n=12) reported they were worried or very worried. Twelve (63.2%) had a prenatal consultation with a urology provider, and 50% (n=6) reported their anxiety was not relieved or even worsened following consultation. The mean STAI-S score was 42.5 (range, 22-69), indicating moderate state anxiety. Severity of hydronephrosis, measured in the pre (p=0.18) or post-natal (p=0.2) period, was not associated with state anxiety, while the anticipated need for surgery was associated with higher STAI-S scores (p=0.03). Preliminary themes included mixed messages, unknown prognosis, implications for baby, seeking information, and communication from health care provider (Table 2).
Conclusions Antenatal hydronephrosis, which resolves spontaneously for most infants, can still become a significant source of stress and anxiety for mothers. In this study, preliminary data indicate that women had moderate anxiety, regardless of the severity of their infant’s ANH, and that prenatal consultations or the anticipated need for surgery may increase anxiety. Limitations include small sample size, lack of comparison group and retrospective nature. Future directions include a prospective cohort study to compare women with ANH and a comparison group from the time of ANH diagnosis through the birth of their infant that will evaluate self-reported stress, anxiety, and maternal cortisol.
