Psychological sequelae following second‐trimester termination of pregnancy: A longitudinal study

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 103; no. 9; pp. 1868 - 1876
• Main Authors: Dawood, Yousif, Vries, Jana M., Leeuwen, Elisabeth, Eekelen, Rik, Bakker, Bernadette S., Boelen, Paul A., Pajkrt, Eva
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.09.2024; John Wiley and Sons Inc
• Subjects: Abortion, Induced - psychology; Adult; Birth; Female; fetal anomalies; fetal donation; Grief; Humans; Longitudinal Studies; Male; Netherlands; Original; Postpartum depression; Pregnancy; Pregnancy Trimester, Second - psychology; psychological well‐being; Quality of Life; Questionnaires; Surveys and Questionnaires; termination of pregnancy; Women; Netherlands; fetal anomalies; fetal donation; termination of pregnancy; psychological well‐being
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14848

Introduction The decision to terminate a pregnancy due to fetal anomalies can have a significant emotional impact, especially in second‐trimester terminations. Previous studies on the psychological consequences of pregnancy termination have had limitations, and little is known about the outcomes for partners and the impact of fetal donation. Therefore, we aimed to investigate the psychological effects of second‐trimester pregnancy termination and identify factors associated with outcomes in both women and men, including donation of fetal remains to science. Material and Methods A longitudinal cohort study was conducted at the Amsterdam UMC in the Netherlands, involving women and partners who underwent termination at or before 23 weeks and 6 days of gestation. Questionnaires were administered at termination, 6 weeks, and 4 months after. We utilized validated questionnaires to assess psychological morbidity (grief, post‐traumatic stress and postnatal depression and quality of life [QoL]), and factors that could potentially influence outcomes. Results Of 241 participants, women displayed more pronounced psychological distress than men, though both groups improved over time. Four months after termination, 27.4% of women and 9.1% of men showed signs of pathological grief. Scores indicative for postnatal depression occurred in 19.8% women and 4.1% of men. A prior psychiatric history was a consistent predictor of poorer outcomes. Fetal donation to the Dutch Fetal Biobank was associated with reduced likelihood of symptoms of complicated grief four months after termination. Conclusions Second‐trimester termination of pregnancy for fetal anomalies can lead to psychological morbidity, particularly in women. However, there is a notable improvement over time for both groups. Individuals with prior psychiatric history appear more vulnerable post‐termination. Also, fetal donation to science did not have a negative impact on psychological well‐being. Women experience more psychological distress than men after second‐trimester TOP, both groups improve significantly over time. Prior psychiatric history predicts poorer outcomes, fetal donation shows no negative effect.