Maternal perception of the risk of vertically transmitted infections: the impact of expert counseling

Abstract

Background: Insufficient and imprecise information during pregnancy can lead to an overestimation of maternal and fetal risk associated to various exposures during gestation.

Objective: This study aimed to assess whether expert obstetrical counseling in cases of maternal infections at risk of vertical transmission could impact maternal perception of risk and the tendency to terminate pregnancy.

Study design: This is a monocentric prospective observational study of 185 consecutive pregnant women with confirmed diagnosis of infectious diseases at risk of vertical transmission during the first or second trimester of pregnancy. Patients were divided into 2 different groups, according to the type infectious disease: infections at high risk of fetal damages and infections at low risk. Every woman included in the study underwent medical counseling with a physician with experience of vertically transmitted infections. Moreover, each woman involved in the study was offered a detailed second trimester ultrasound scan. Maternal concern for their pregnancy and the disposition to interrupt the pregnancy were investigated by 2 questionnaires submitted to patients before and after medical expert counseling; a third questionnaire was completed only by those women who decided to undergo second trimester ultrasound scan at our hospital.

Results: Of the 185 consecutive patients meeting the inclusion criteria, 171 (92.4%) filled out the visual analog scale for concern about the baby's health both before and after medical consultation. After medical consultation, there was a significant decrease in mean visual analog scale for concern: from 67.1±26.0 to 41.3±28.8 (change score, -25.8; 95% confidence interval, -29.9 to -21.7). Higher baseline levels of concern had more room for reduction, and infections at high fetal risk of damage were associated with lower decrease in concern. However, risk perception decreased in both low-risk and high-risk pregnancies. Notably, 82 patients (53.2%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 28.3±24.4 and significantly lower than the mean score registered after consultation (change score, -16.6; 95% confidence interval, -22.9 to -10.3). A total of 162 women (87.6%) declared their tendency to interrupt pregnancy both before and after the consultation. There was a significant decrease in mean tendency from 42.1±32.6 to 22.7±27.1 (change score, -19.4; 95% confidence interval, -23.6 to -15.2). Regression analysis revealed that both low- and high-risk patients significantly reduced their tendency. A total of 73 patients (45.1%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 9.9±20.6 and significantly lower than the mean score registered after consultation (change score, -13.4; 95% confidence interval, -19.1 to -7.7).

Conclusion: Our results confirm the importance of a comprehensive and sufficient expert medical counseling that, on one hand, can reduce maternal risk perception, improving quality of life for mothers, and, on the other hand, can lead to feasible results, reducing a woman's disposition to termination of pregnancy.

Keywords: counseling; risk perception; termination of pregnancy; vertically transmitted infections.