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The Correlation Between Anxiety
and Depression Levels and
Functional Capacity in Pregnant
Women with Cardiac Disease
Alona Winkler
Smadar Truman
Michal J. Simchen
Hana Kerzman
Rafael Kuperstein.
Leviev Heart Center, Sheba Medical Center,
Tel Hashomer, Israel
Background
 Anxiety and Stress increase in pregnancy when
cardiac function is diminished
 Pregnant women with heart disease tend to suffer
from complications
 Pregnancy causes a significant, permanent increase
in heart function (cardiac output)
The Importance of this Research
 The findings of this study will impact on setting up
an interventional, follow-up program.
 A combined multidisciplinary team, which would
include both cardiac and gynecological expertise
Goal
1. To evaluate anxiety and stress levels
2. To evaluate the functional capacity according to
the New York Heart Association (NYHA)
functional class guidelines
3. To evaluate the relationship between functional
capacity and anxiety and stress levels
4. To map the cardiac complications during
pregnancy and after delivery
Assumption
 We hypothesized that there is a direct correlation
between functional capacity (NYHA) and anxiety and
depression.
 We hypothesized that there is a direct correlation
between cardiac complications during pregnancy and
after delivery, and levels of anxiety and depression.
Methods
 A follow-up longitudinal study among pregnant
women at 3 different time points.
 Study population: 47 pregnant women with cardiac
disease treated at the Leviev Heart Center, Sheba
Medical Center at Tel Hashomer
Population
Pregnant Women
with Heart disease
N= 114
Not suitable
N=67
3 Withdrew
Suitable
N=47
Answered the
First & Second
Questionnaire
N =44
Answered the
Third
Questionnaire
after delivery
N=44
Demographic Characteristics
N
%
20-30
14
31.8
31-40
19
65.9
41-50
1
2.3
Unmarried
3
6.8
Married
41
93.2
High School
11
26.8
Academic
30
73.2
Working
32
78.0
Full Job
28
87.5
Normal Delivery
22
50.0
First Delivery
14
31.8
Age
Familial Status
Education
woman’s Diagnosis
Disease
N
%
Valvular Disease
13
29.5
CMP
10
22.7
Low Cardiac out
put after
chemotherapy
1
2.27
Other cardiac
problems
All
20
45.4
44
100
Tools
 Demographic Questionnaire
 Anxiety Questionnaire (Spielberger, 1970 )
 Depression Questionnaire (The Beck Depression
Inventory )
 Functional Capacity - New York Heart Association
functional (Classification NYHA ).
The study was conducted in 3 stages ;
 After 3 months of pregnancy
 After 6 months of pregnancy
 1 month post delivery.
Results
p=0.015.
First Trimester Second Trimester
After
Delivery
Class I
N= 39(86%)
N=27 (66%)
N=39
(88.6%)
Class II
N= 4 ( 9% )
N=10 (23%(
N=3 (6.8)
Class III
N= 1 (2%)
N=3 (7% )
N=1 (2.3)
Level of Anxiety during the 3 stages of
the study
40
34.5
34
30
31.1
20
10
0
1st Trimester
2nd Trimester
After Delivery
The relation between anxiety and
Functional Capacity
Conclusions
 The study was limited by the small sample size.
 we recommend a further study emphasizing on this
group of women.
 In the light of our findings we plan a follow up study
from start of pregnancy to deal with the complex
problem of anxiety in high risk pregnant women.
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