Parents' mental health after termination of pregnancy for foetal anomaly - a systematic review

Terminating a desired pregnancy due to foetal anomalies has been linked to significant distress. It is however less clear what long-term psychological implications the parents face in the aftermath. This systematic review aimed to explore the mental health outcomes of parents after the termination of pregnancy due to foetal anomaly (TOPFA) after gestational week 12 + 0.

Following the PRISMA guidelines and using the PEO (Problem, Exposure, Outcome) framework, we conducted a comprehensive search across six electronic databases. The search was restricted to English studies published since 2000. Eligible studies provided quantitative assessments of mental health outcomes post-TOPFA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Given the heterogeneity in outcome measures, the findings were synthesised narratively.

Of the 2261 papers identified, 11 studies (four cross-sectional and seven cohort studies) were included. Results demonstrated variations in symptoms of trauma-related stress, depressive symptoms, and grief reactions across the different studies post-TOPFA. Variations were found to be related to time since TOPFA and the difference in assessment tools used. Factors investigated as predictors of mental health outcomes, including gestational age, educational level, and religion, showed inconsistent findings, though partner support consistently correlated with lower levels of grief. Male partners, included in two studies, generally reported fewer symptoms of psychological distress.

This review explores a range of mental health outcomes and highlights the need for better quality studies that consider the psychological impact of TOPFA on partners. Further, this systematic review stresses the need of standardisation in measurement tools for assessing mental health symptoms.