STUDY QUESTION

Is anxiety focused on the pregnancy outcome, known to be particularly salient in women conceiving through assisted reproductive technology (ART), related to difficult infant temperament?

SUMMARY ANSWER

While trait anxiety predicts infant temperament, pregnancy-focused anxiety is not associated with more difficult infant temperament.

WHAT IS KNOWN ALREADY

A large body of research has provided convincing evidence that fetal exposure to maternal anxiety and stress in pregnancy has adverse consequences for child neurodevelopmental, behavioural and cognitive development, and that pregnancy-specific anxiety (concerns related to the pregnancy outcome and birth) may be of particular significance. Women conceiving through ART are of particular interest in this regard. Research over more than 20 years has consistently demonstrated that while they do not differ from spontaneously conceiving (SC) women with respect to general (state and trait) anxiety, they typically report higher pregnancy-specific anxiety. While research suggests normal behavioural and developmental outcomes for children conceived through ART, there is some evidence of more unsettled infant behaviour during the first post-natal year.

STUDY DESIGN, SIZE, DURATION

The longitudinal cohort design followed 562 nulliparous women over a 7-month period, during the third trimester of pregnancy and at 4 months after birth.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Approximately equal numbers of nulliparous women conceiving through ART (n = 250) and spontaneously (SC: n = 262) were recruited through ART clinics and nearby hospitals in Melbourne and Sydney, Australia. Participants completed three anxiety measures (state, trait, pregnancy specific) at time 1 in the third trimester of pregnancy and a measure of infant temperament at time 2, 4 months after birth. At time 1, relevant socio-demographic, pregnancy (maternal age, smoking, alcohol, medications, medical complications) information was recorded and at time 2, information regarding childbirth (gestation, infant birthweight, mode of delivery) and post-natal (concurrent mood) variables was recorded and controlled for in analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

In the third trimester of pregnancy, women conceiving through ART reported lower state and trait anxiety, but higher pregnancy-focused anxiety than their SC counterparts (all Ps < 0.05). Hierarchical regression analyses including mode of conception, all anxiety variables and relevant covariates indicated that while trait anxiety in pregnancy predicted more difficult infant temperament (P < 0.001), pregnancy specific and state anxiety did not. Mode of conception predicted infant temperament; with ART women reporting less difficult infant temperament (P < 0.001) than their SC counterparts.

LIMITATIONS, REASONS FOR CAUTION

The major limitations in the study are the reliance on a self-report measure of infant temperament and the fact that the study did not assess quality of caregiving which may moderate the effect of pregnancy anxiety on infant temperament.

WIDER IMPLICATIONS OF THE FINDINGS

This study is the first to our knowledge to prospectively examine the impact of gestational stress (pregnancy anxiety) on infant temperament in women conceiving through ART. Findings confirm existing research indicating that trait anxiety in pregnancy is associated with difficult infant temperament and suggest that pregnancy-specific anxiety (measured in the third trimester) is not implicated. These findings are reassuring for women conceiving through ART whose pregnancies may be characterized by particularly intense concerns about the wellbeing of a long sought after baby.

STUDY FUNDING/COMPETING INTEREST(S)

The study was funded by a grant from the Australian Research Council (ARC) and in kind and financial contributions from IVF Australia and Melbourne.

TRIAL REGISTRATION NUMBER

N/A.

Source:
http://humrep.oxfordjournals.org/cgi/content/short/28/4/997?rss=1

Recommendation and review posted by G. Smith

STUDY QUESTION

How do young women, who were identified as carrying a BRCA gene mutation before they had children, approach reproductive decision-making and what are their attitudes towards reproductive genetic testing?

SUMMARY ANSWER

Reproductive decision-making within the context of cancer risk is complex and influenced by personal experiences of cancer. Younger women were not concerned with reproductive decision-making at the time of their genetic test; however, the impact on subsequent reproductive decision-making was considerable and left them with unanticipated dilemmas, such as having children who would be at risk of inheriting cancer predisposition, timing risk-reducing surgery and changing perceptions of responsibility.

WHAT IS KNOWN ALREADY

Individuals carrying gene mutations predisposing to hereditary breast/ovarian cancer have concerns about passing on the gene mutation to children.

STUDY DESIGN, SIZE, DURATION

Qualitative methodology and thematic analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data were collected through semi-structured interviews with 25 women aged 18–45 who had received a positive result for a BRCA1 or BRCA2 gene mutation while childless.

MAIN RESULTS AND THE ROLE OF CHANCE

Analysis revealed four central themes: (i) the impact of cancer on reproductive decision-making; (ii) motivation for genetic testing; (iii) risk management and timing of planning children; and (iv) optimism for future medical advancements.

LIMITATIONS, REASONS FOR CAUTION

This study explores the views of female BRCA carriers. Further research should explore the views of couples, men, and include samples with greater ethnic and social diversity.

WIDER IMPLICATIONS OF THE FINDINGS

This evidence highlights the need for reproductive decision-making to be addressed at the time of pretest genetic counselling. More information should be provided on reproductive options as well as counselling/support to guide women's reproductive decision-making and prenatal testing options at the time they undertake genetic testing.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by Cancer Research UK (Number C1226 A7920) and NIHR support to the Biomedical Research Centre at The Institute of Cancer Research and RMH. The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

Not applicable.

Source:
http://humrep.oxfordjournals.org/cgi/content/short/28/4/1006?rss=1

Recommendation and review posted by G. Smith

STUDY QUESTION

What information is shared on Dutch internet forums with regard to infertility treatment in Belgium?

SUMMARY ANSWER

The online discussion mainly regards medical treatments, feelings and experiences, and financial implications. The general tone of the discussion on the forums about fertility treatment in Belgium is that Belgian clinics offer better quality of care.

WHAT IS KNOWN ALREADY

The internet is the most important source of information for cross-border patients. Many Dutch patients visit Belgian clinics for infertility treatment.

STUDY DESIGN, SIZE, DURATION

This study comprised an inductive thematic analysis of eight Dutch internet forums about infertility.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All the threads that were active in a 15-month period (October 2010–December 2011) were retrieved and checked for relevance. This resulted in 77 threads containing 1813 posts that were used for thematic analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

Eight themes emerged after data analysis: medical expertise and testing, feelings and experiences, costs, trying out different clinics, travel and waiting times, treatments in the Netherlands, cooperation between clinics/physicians and laws and regulations. Our analysis of shared patient experiences indicates that patients identify respect for the person behind the patient as the fundamental reason why quality of care is higher in Belgium. They define this respect as active involvement in the medical decision-making process, which is considered a form of patient-centred care.

LIMITATIONS, REASONS FOR CAUTION

The data from internet forums are not representative of the experience of Dutch IVF patients in Belgium. We are presenting a thematic analysis of information that circulates on the web, not making statements about IVF treatment in Belgium or the Netherlands.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first study on what information (future) cross-border patients are likely to find when they look for information online.

STUDY FUNDING/COMPETING INTEREST(S)

W.V.H. has a Ph.D. grant and V.P. holds a Postdoctoral Mandate by the Flemish Foundation for Scientific Research (FWO-Vlaanderen). G.P. is supported by a full-time stipend at Ghent University. There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Source:
http://humrep.oxfordjournals.org/cgi/content/short/28/4/1013?rss=1

Recommendation and review posted by G. Smith