Perception of Teratogenic Risk and the Rated Likelihood of Pregnancy Termination: Association with Maternal Depression

By Walfisch, Asnat; Sermer, Corey et al. | Canadian Journal of Psychiatry, December 2011 | Go to article overview
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Perception of Teratogenic Risk and the Rated Likelihood of Pregnancy Termination: Association with Maternal Depression


Walfisch, Asnat, Sermer, Corey, Matok, Ilan, Einarson, Adrienne, Koren, Gideon, Canadian Journal of Psychiatry


Objective: Women are often exposed to various medications and medical conditions during pregnancy. Unrealistically high maternal teratogenic risk perception, related to these exposures, may lead to abrupt discontinuation of therapy and (or) termination of a wanted pregnancy. The association between maternal depression and the teratogenic risk perception has not been studied, nor were the actions resulting from this perception. Our objectives were to explore the association between maternal depression, teratogenic risk perception, and the rated likelihood to terminate pregnancy. Additionally, we evaluated possible benefits of counselling.

Methods: We administered the Edinburgh Postnatal Depression Scale (EPDS) to all women who attended the Motherisk Clinic between October 2007 and April 2010. A visual analogue scale was used to determine maternal risk perception in relation to the specific exposure, and the rated likelihood to terminate the pregnancy, before and after counselling.

Results: We analyzed data from 413 women. Maternal teratogenic risk perception and the rated likelihood to terminate the pregnancy were significantly lower following counselling. An EPDS score of 13 or more was significantly associated with a higher rated likelihood to terminate the pregnancy (P = 0.03). In a multivariable regression analysis, an EPDS score of 13 or more was found to be an independent predictor of a higher personal teratogenic risk perception (P = 0.03).

Conclusions: Both maternal depression and exposure-directed counselling are associated with maternal risk perception and the rated likelihood to terminate pregnancy. Appropriate counselling may reduce fear of teratogenicity and the likelihood of pregnancy termination.

Can J Psychiatry. 2011;56(12):761-767.

Clinical Implications

* Counselling women about different exposures in pregnancy may reduce a maternal fear of potential teratogenicity.

* Maternal depression is associated with a mother's perception of exposure-related teratogenic risk and the rated likelihood to terminate the pregnancy.

* Addressing maternal depression in this setting may result in improved perinatal outcome.

Limitations

* The study population has specific characteristics and generalizability of the conclusions should be confirmed.

* The finding that counselling results in a reduction in risk perception may reflect a maternal need to please the counsellor rather than a mother's true perception.

* Maternal-rated likelihood to terminate the pregnancy does not necessarily reflect a mother's actual future action.

Key Words: counselling, Edinburgh Postnatal Depression Scale, maternal depression, teratogenic risk perception

Abbreviations

AD antidepressant

EPDS Edinburgh Postnatal Depression Scale

VAS visual analog scale

Women are often exposed to various medications and medical conditions during pregnancy. Teratogenic risk perception related to such exposures is often unrealistically high among pregnant women. M This may result in discontinuation of treatment for even life-threatening medical conditions1 or termination of an otherwise wanted pregnancy when exposure occurs.2-5 Sudden discontinuation of medications during pregnancy may lead both to withdrawal symptoms, as well as to re-emergence of the primary disorder.6

In previous work,2 we have assessed the perception of teratogenic risk by 80 women attending an antenatal consultation service for different exposures in pregnancy. Women exposed to agents not known to be teratogenic assigned themselves a significantly higher risk for fetal major malformation before the relevant medical literature was delivered. These women accurately estimated their personal risk for major malformation following the counselling session. The rated likelihood to terminate pregnancy (when exposed to a nonteratogen) significantly decreased after the consultation.

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