(1141) Impact of Fetal Surgery Type and Complications on Maternal Perinatal Mental Health

Previous work has identified high rates of depression and anxiety in fetal surgery patients, therefore, we sought to determine the effect of fetal surgery approach type and outcomes on perinatal mood and anxiety disorders (PMAD).

Study Design:

A retrospective chart review was conducted of fetal surgery patients from 2017-2024 at a tertiary care center. Demographics, surgical, obstetric, and psychiatric diagnoses were recorded. Complications included surgical site infection, chorioamnionitis, NICU admission > 45 days, PPROM, preterm labor, or delivery < 34 weeks gestation. Severe complications included delivery < 30 weeks gestation, unplanned delivery at the time of the procedure, maternal ICU admission, and fetal or neonatal death. Minimally invasive surgery (MIS) included both fetoscopic and ultrasound guided.

Results:

Our cohort had an average age of 30.5 yrs and a mean gravidity of 2.7 (n=141). Of 141 surgeries, 32 (22.7%) were open and 109 (77.3%) were MIS. Pregnancy complications occurred in 115, with severe complications in 64 patients (Table 1). The rates of any or severe complications were 75.0%, 21.9%, respectively, for open procedures and 83.5%, 52.3%, respectively, for MIS. MIS patients did not have a lower rate of exacerbation or de novo PMAD (25/109, 22.9%) compared to open surgery (8/32, 25.0%, p=0.8084; Χ² test). Patients with any complication did not have a higher risk of exacerbation or de novo PMAD (30/115, 26.1%), versus patients without any complications (3/26, 11.5%, p=0.1315; Fisher’s exact test). After adjusting for multiple testing, no individual complication was predictive of subsequent PMAD. Among patients with baseline mood disorders, complications did not result in increased exacerbation compared to no complications (2/5, 40% without vs 25/48, 52.1% with, p=0.6687; Fisher’s exact test).

Conclusion:

Both complications and surgical approach are not predictive of PMAD; universal follow-up and screening are needed. Further research is necessary to determine the most effective timepoints and methods of screening in this population with a uniquely challenging life event.