Assessing the psychological effect and acceptability of a first trimester screening test for pre-eclampsia

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Background
A first-trimester prenatal screening test for pre-eclampsia was launched in 2010. It differs from previously assessed prenatal screening tests in three ways; (i) it provides a health threat that impacts both mother and fetus (ii) it does not have an associated diagnostic test, or risk-reduction intervention; (iii) it informs the mother, for the first time, that her pregnancy has the potential to harm her. Women found to be at high risk for pre-eclampsia receive specialist care including a 4-weekly ultrasound scan to aid detection of the disease at the earliest opportunity.
Aims
(i) To assess the psychological benefits and consequences of providing a first trimester screening test for pre-eclampsia.
(ii) To assess the acceptability of the test amongst pregnant women and healthcare professionals.
Methods
A theoretically informed, mixed methods, sequential approach was taken. The studies were informed by a review of theoretical and empirical evidence regarding prenatal health screening. Five consecutive studies using primary and secondary data from UK pregnant women and their healthcare providers were conducted:
1. A systematic literature review to investigate whether psychological reactions to prenatal screening tests differ depending on whether they focus on the mother or the fetus;
2. Semi-structured interviews with women who had experienced the pre-eclampsia screening test (n=15) to explore the psychological impact of the screening test. This study was informed by the Common-Sense Model of self -regulation;
3. Semi-structured interviews with healthcare professionals who had provided care for women following the pre-eclampsia screening test (n=20). This study was informed by the themes developed from Study 2;
4. A case control study (n=1100) that investigated whether there was an association between the number of ultrasounds a woman receives in her pregnancy and the place of birth she chooses;
5. A discrete choice experiment comparing four attributes (accuracy of test, level of information, schedule of follow-up, and test format) in a binary choice format amongst pregnant women (n=119), women who had previously experienced pre-eclampsia (n=111) and healthcare professionals (n=76).
Results
Pregnant women are affected by prenatal screening test differently, depending on whether the test focussed on the impact to the mother or the fetus. A first trimester screening test for pre-eclampsia did not appear to cause an unacceptable increase in anxiety. It showed potential to positively change health behaviours, but also to decrease self-monitoring. The impact differed depending on whether the woman was concerned about the potential consequences to herself or her fetus. Healthcare professionals were concerned with the clinical utility of the prenatal screening test, and on its potential to medicalise the pregnancy pathway. However, there did not appear to be an association with the amount of technological monitoring in pregnancy, and a woman’s assessment of medical risk, as measured by chosen place of birth. The Discrete Choice Experiment showed overwhelming support for a biochemical screening test for pre-eclampsia, with accuracy and test format being the most valued attributes.
Conclusions
There is no evidence that this new prenatal screening test will cause harm to pregnant women. Women appear to welcome the additional information it provides. Results suggested that reactions to prenatal screening tests were linked to illness representations of the health threat, with a perceived threat to the self associated with a stronger sense of control and a perceived threat to the fetus resulting in a dependence on healthcare providers.
Receiving a positive PE screening result presents potential opportunities for health promotion interventions. To make the most of these opportunities, it will be important for clinicians to understand how women perceive and respond to this screening test; the self-regulation model provides a useful framework in which to do this. This work provides a framework for assessing the psychological impacts of the many emerging prenatal screening tests that lack a diagnostic test or risk-reduction intervention.
Date of Award28 Jan 2015
Original languageEnglish
Awarding Institution
  • UCL University College London
SupervisorSusan Michie (Supervisor) & Linda S. Franck (Supervisor)

Cite this

'