Patient-Reported Burdens of Undergoing Antenatal Fetal Surveillance

Antenatal fetal surveillance (AFS) is recommended to prevent stillbirth in high-risk pregnancies. Data assessing the patient experience of these regimens are lacking. We aimed to describe the patient-reported burdens of attending AFS and analyze associations between visit frequency, over time, and with pregnancy and demographic characteristics.

This is a cross-sectional survey of patients attending AFS. The survey was available in English and Spanish and could be taken serially. Patients answered demographic questions and rated their agreement regarding how attending AFS burdened their life in multiple domains on a 7-point Likert scale. Responses between once- and twice-weekly testing groups were compared. To examine characteristics contributing to high burden, demographic and patient-level factors were compared using chi-square and Fisher's exact tests. Participant score of burden between their first and last completion were assessed. Patient and provider indications were compared.

There were 189 respondents (156 with one completion, 33 with serial completions). Most respondents had children and did not work outside the home; 149 (78.8%) attended once weekly. Almost half of all respondents reported experiencing burden. Twice-weekly patients were significantly more likely than once-weekly patients to report that AFS interfered with work (p = 0.02), was too expensive (p < 0.01), required cost cutting (p < 0.02), and missed AFS visits (p = 0.03). Compared with the "no burden" group, the burdened group were older (32.4 vs. 28.6 years, p < 0.01), more likely to attend twice weekly testing (31.7 vs. 15.4%, p < 0.01), and to report diabetes (24.4 vs. 9.6%, p < 0.01). There was no difference in burdens over time in those with multiple completions. Patients underreported obesity as an indication for AFS.

This is the first documented report showing that burdens are commonly reported by patients undergoing AFS. More patient-centered work is needed exploring these findings so that AFS may minimize harm and maximize benefit.

· When patients in a maternal-fetal medicine antenatal testing unit were surveyed regarding burdens in domains related to employment, finances, and childcare, 14 to 42% of patients reported some degree of burden in at least one domain.. · Burdens were increased for patients who were prescribed twice-weekly compared with once-weekly schedules. The patients who reported burdens were more likely to be older and have gestational diabetes.. · These novel findings of patient-experienced burdens should prompt providers to use shared decision-making when developing AFS regimens..