Social support as a protective factor for psychological outcomes in pregnant women and motherhood with congenital heart disease

Nicole Wolfrum (München)1, A. Freiberger (München)1, S. Freilinger (München)1, A. Klinghardt (München)1, N. Nagdyman (München)1, P. Ewert (München)1, H. Kaemmerer (München)1, M. Huber (München)1, J. Beckmann (München)1

1Deutsches Herzzentrum München Klinik für angeborene Herzfehler und Kinderkardiologie München, Deutschland


Background: About 8 700 children are born with congenital heart disease (CHD) in Germany every year. Due to the increasing number of treatment options, more than 95% of these children will reach adulthood and with that the reproductive age. Just like healthy women, women with CHD want to have children and start a family. If there is a medical or psychological burden associated with the CHD, pregnancies are often referred to as high-risk pregnancies. Resulting emotional distress can adversely impact pregnancy, motherhood and fetal health. The present study aims to retrospectively investigate psychological outcomes and the potentially protective factor of perceived social support in postpartum women with CHD.

Methods: Self-reported measures on postpartum depression (EPDS), depression and anxiety (HADS) and perceived social support (F-SozU S-54) were assessed in a sample of 180 postpartum women with CHD (mean age: 43 ± 9.8 [25 – 81] years) at the German Heart Centre Munich between August 2021 and November 2023. Descriptive analyses and inferential statistical methods were calculated.

Results: Before pregnancy, 68% of all women were afraid of passing their CHD onto their offspring. Thereof, 19.5% reported that their fear had an influence on their desire to get pregnant.  Women who were afraid of inheriting the CHD demonstrated higher scores in postpartum depression (rs=.180, p=.018). Overall, the mean score of postpartum depression was 7.2 +/- 5.7 [0-27]. Perceived social support (partner, family, close friends) at the time of delivery was high with 8.7 +/- 2.1 [0-10] and associated with lower scores in postpartum depression (rs=-.150, p=.049). Additionally, perceived social support at the time of data collection was 3.6 +/- .60 [1.4 – 4.3]. In total, 26.7% of all women were above cut-off values for depression and 37.2% for anxiety. Perceived social support had a protective effect on depression (rs=-.217, p=.04) and anxiety (rs=-.224, p=.03).

Conclusion: Prenatal emotional distress in women with CHD was associated with higher risk for postpartum depression. In general, perceived social support seems to have a noticeable protective influence on (postpartum) depression and anxiety in this patient population. Consequently, the involvement of partners, families and close social network should become an integral part of patient care for pregnant women with CHD.

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