Psychological impact of fetal echocardiography referral on pregnant women with a normal routine morphological ultrasound

Background Foetal echocardiography (FE) is widely recommended in pregnancies at increased risk of congenital heart defects. While FE is a safe diagnostic tool, its psychological impact on expectant pregnant women remains poorly understood. Methods We conducted a prospective observational study in eight Canadian centers. Women aged ≥18 years with a normal second-trimester ultrasound between 18 and 26 weeks' gestation referred for a FE were compared to women who were not. Anxiety was assessed using the Spielberger State–Trait Anxiety Inventory (STAI). The primary outcome was the difference between state and trait anxiety (net situational anxiety) after morphological ultrasound, but before FE (T0). Secondary outcomes included the proportion of participants with significant anxiety (STAI ≥40) and anxiety trajectories after FE among referred participants. Results Eighty-four women were included, of whom 38 were referred for FE. At T0, women referred for FE showed slightly higher median net situational anxiety compared with controls. In multivariable analyses, FE referral was associated with a modest increase although estimates were imprecise. A higher proportion of referred women reached a state anxiety score ≥40, though this association was weak after adjustment. Among the 14 women who completed post-FE questionnaires, anxiety trajectories were heterogeneous, with both increases and decreases observed following FE. Conclusions Referral for FE following a normal second-trimester ultrasound is associated with a small and variable increase in maternal anxiety. These findings suggest that FE referral may not be psychologically neutral and highlight the importance of considering maternal psychological responses as referral criteria broaden.