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Graduate Student Journal of Psychology
2022, Vol. 19

Copyright 2022 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Parents’ Psychological Adaptation after Receiving a     
Fetal Diagnosis: A Systematic Review

Catherine R. Gaspar, 
Teachers College, Columbia University

A fetal diagnosis places an unexpected psychological burden on parents and triggers a complex pregnancy experience. Par-
ents who choose to continue the pregnancy have unique perspectives as they prepare for birth. It is crucial to understand 
these families’ experiences to inform their care and support. This qualitative systematic review explored the psychologi-
cal adjustment of parents who continued gestation after they received a fetal diagnosis. A systematic database search was 
conducted with subsequent thematic analysis of fourteen included studies. Parents experienced intense initial emotion-
ƺǹ�ȖǓƺǉȠǩȅǿș�Ƞȅ�ȠǦǓ�ǏǩƺǠǿȅșǩș�ǩǿǉǹȣǏǩǿǠ�șǦȅǉǷ�ƺǿǏ�ǠȖǩǓǟॹ�ǟȅǹǹȅΛǓǏ�ǈΡ�ƺ�ǉȅǾȒǹǓΠ�ȒȖȅǉǓșșǩǿǠ�ȒǓȖǩȅǏ�ǩǿМȣǓǿǉǓǏ�ǈΡ�ȒǓȖșȅǿƺǹ�
ƺǿǏ�șȅǉǩƺǹ�ǟƺǉȠȅȖșঀ�eǦǓ�ЙǿǏǩǿǠș�ǏǓǾȅǿșȠȖƺȠǓ�ƺ�ǿǓǓǏ�ǟȅȖ�ǩǾȒȖȅΚǓǏ�ǾȣǹȠǩǏǩșǉǩȒǹǩǿƺȖΡ�ȒƺȖǓǿȠƺǹ�șȣȒȒȅȖȠ�ǟȅȖ�ǟƺǾǩǹǩǓș�ΛǦȅ�ȖǓ-
ceive a fetal diagnosis and add rationale for the addition of psychological services to the care teams of prospective parents. 
Keywords: prenatal, fetal diagnosis, pregnancy, parents, emotions, process

 Pregnancy is a time of major life adjustment for 
any parent. Parents who undergo typical pregnancies 
experience changes in lifestyles, emotions, and identi-
ties (Edvardsson et al., 2011). Pregnancies that receive 
a fetal diagnosis place an additional psychological 
burden on prospective parents, especially at the time 
ȅǟ� ǩǿǩȠǩƺǹ� ǩǏǓǿȠǩЙǉƺȠǩȅǿ� শΚƺǿ� ǏǓȖ� ^ȠǓǓǿ� ǓȠ� ƺǹঀॹ� �ষঀࢷࢲࢱࢳ
These stressors continue after birth as the family shifts 
into living daily life with the infant and their specif-
ic developmental needs (Woolf-King et al., 2017). 
 Due to advances in technologies, such as non-
invasive methods, prenatal screenings have become 
standard in much of the developed world (Pös et al., 
2019; WHO, 2012). These screenings are generally 
accepted and perceived as necessary by parents (Aune 
& Möller, 2010, Ekelin et al., 2016), and receiving 
positive, on-track information about their unborn 
child’s development can contribute to a positive preg-
nancy experience (Richter et al., 2020; Wittman et 
al., 2016). However, the widespread use of modern 
screening technologies also means greater detection 
of prenatal conditions such as birth defects or genet-
ic disorders (Carlson & Vora, 2017). Reports show 
that about one in 33 births is complicated by a birth 
defect (CDC, 2008) which can often result in physi-
cal or mental disabilities (Boyle & Cordero, 2005).
 Due to advances in technologies, such as non-
invasive methods, prenatal screenings have become 
standard in much of the developed world (Pös et al., 
2019; WHO, 2012). These screenings are generally 
accepted and perceived as necessary by parents (Aune 
& Möller, 2010, Ekelin et al., 2016), and receiving 
positive, on-track information about their unborn 
child’s development can contribute to a positive preg-

nancy experience (Richter et al., 2020; Wittman et 
al., 2016). However, the widespread use of modern 
screening technologies also means greater detection 
of prenatal conditions such as birth defects or genet-
ic disorders (Carlson & Vora, 2017). Reports show 
that about one in 33 births is complicated by a birth 
defect (CDC, 2008) which can often result in physi-
cal or mental disabilities (Boyle & Cordero, 2005).
� �� ǟǓȠƺǹ� ǏǩƺǠǿȅșǩș� ǩș� ǏǩГǉȣǹȠ� ǿǓΛș� ǟȅȖ� ǟƺǾǩǹǩǓș�
to receive. While many families decide to terminate 
these pregnancies (Hawkins et al., 2012), some fami-
lies decide to continue. In recent years, rates of con-
tinued pregnancy after receiving a fetal diagnosis have 
increased (Madeuf et al., 2016). The decision to con-
tinue a pregnancy is multifaceted. For many parents it 
is an ethical dilemma, with worries over playing God 
and wanting the pregnancy to occur naturally, or they 
feel a sentimental attachment to the fetus (Winn et al., 
2018). The timing of diagnosis also matters. Parents 
farther along in gestation have a greater likelihood of 
choosing to continue the pregnancy (Madeuf et al., 
2016; Michalik & Preis, 2013; Winn et al., 2018). Ad-
ditionally, diagnosis severity and other variables play a 
role, where less severe fetal diagnoses and conditions 
with a history of greater postnatal success have a higher 
likelihood of pregnancy continuation (Hawkins et al., 
2012; Madeuf et al., 2016; Winn et al., 2018). Other so-
cio-contextual factors such as parental education, race, 
ǠǓȅǠȖƺȒǦǩǉ� ǹȅǉƺȠǩȅǿॹ�ƺǿǏ�ЙǿƺǿǉǓș�ƺǹșȅ� ǩǾȒƺǉȠ�ȠǦǓ�ǏǓ-
cision (Hawkins et al., 2012; Michalik & Preis, 2013). 
 For parents, the decision to continue pregnancy 
rather than terminate may improve their psycholog-
ǩǉƺǹ�ȅȣȠǉȅǾǓș� শ�ȅȒǓ� ǓȠ� ƺǹঀॹ� �ষॹࢶࢲࢱࢳ ƺ� ǉȖȣǉǩƺǹ�ǈȣАǓȖ� ƺș�
prospective parents already face vulnerabilities to their 



32

mental health during pregnancy (Cindy-Lee et al., 
2017; Condon et al., 2004; Davalos et al., 2012). In typ-
ical pregnancies, factors such as lower socioeconomic 
șȠƺȠȣșॹ�Йǿƺǿǉǩƺǹ�ǦƺȖǏșǦǩȒșॹ�ΡȅȣǿǠǓȖ�ǾƺȠǓȖǿƺǹ�ƺǠǓॹ�ƺǿǏ�
histories of prior mental health struggles, put women 
at an increased risk for mental health conditions such 
as depression (Rich-Edwards et al., 2006). Lower so-
cial support is also a risk factor; parents with low social 
support may lack social networks which can provide 
advice, information, and reduce negative emotions 
that may result from stressors (Bedaso et al., 2021). 
 However, many factors can act protectively for 
prospective parents’ psychological health, such as 
high social support which may promote psychological 
well-being (Corno et al., 2022). A qualitative study on 
public health clinics found that pregnant mothers uti-
lized friendships to manage stress and relieve tension 
through venting and laughing together (Abdou et al., 
2010). Similarly, relationship quality and partner sup-
port act as protective factors. Involved partners and 
șȠȖȅǿǠ� ȖǓǹƺȠǩȅǿșǦǩȒș� ǦƺΚǓ� ǈǓǓǿ� ǟȅȣǿǏ� Ƞȅ� ǈǓǿǓЙȠ�Ǿƺ-
ternal well-being for mothers undergoing typical preg-
nancies (Rini & Dunkel Schetter, 2010). Other liter-
ature on typical pregnancies has demonstrated that 
social support, family functioning, and relationship 
șƺȠǩșǟƺǉȠǩȅǿ� ǈȣАǓȖǓǏ� ǹǩǿǷș� ǈǓȠΛǓǓǿ� șȠȖǓșșǟȣǹ� ǓΚǓǿȠș�
and depression (Divney et al., 2012). In recent work 
ȅǿ�șȒǓǉǩЙǉ�șȠȖǓșșǟȣǹ�ǹǩǟǓ�ǓΚǓǿȠșॹ�șȣǉǦ�ƺș�ȠǦǓ��Kt2�েࢺࢲ�
pandemic, support from partners, social networks, 
ƺǿǏ�ǦǓƺǹȠǦǉƺȖǓ�ȒȖȅΚǩǏǓȖș�Λƺș�ǩǏǓǿȠǩЙǓǏ�ƺș�ȒǹƺΡǩǿǠ�ȒȖȅ-
tective roles in the mental health of pregnant wom-
en (Khoury et al., 2021; Vacaru et al., 2021). Further 
support can stem from parents’ mindsets. Pregnant 
women who engaged in emotion-focused coping in 
early and middle pregnancy had lower distress (Huiz-
ink et al., 2002), and those with more positive cogni-
tive appraisal in stressful life events like COVID-19 
had less mental health problems (Khoury et al., 2021). 
Utilization of belief systems like religion or spiritual-
ity as a source of guidance or comfort has also been 
suggested as helpful factors (Abdou et al., 2010).
 Further support of mental health vulnerabilities 
in pregnancy may be the receipt of psychological ser-
vices (Kinser et al., 2021; Urizar et al., 2019), yet cur-
rently, many prospective parents undergoing typical 
pregnancies struggle to access adequate psychologi-
cal services (Schwartz et al., 2021). Pilot intervention 
programs have been implemented to facilitate access 

to services (Slade et al., 2021), yet less is known about 
ȣǿǩΚǓȖșƺǹ�ȅȖ�ǈȖȅƺǏǓȖ�ǓАȅȖȠșঀ�^ȣȒȒȅȖȠǩǿǠ�ȠǦǓ�șȒȖǓƺǏ�ȅǟ�
information, the internet has helped aid parents to ac-
cess informational resources (Fleming et al., 2014) Re-
cent years have seen the development and utilization 
of e-mental health tools, where parents use web-based 
strategies for the delivery or enhancement of mental 
health information and services (Fonseca et al., 2016). 
For high-risk pregnancies, including those with fetal 
diagnoses, formal social supports (e.g., targeted sup-
port networks within peers or practitioner-facilitated 
ǠȖȅȣȒșষ� ƺȖǓ� ƺǹșȅ� ǏȅǉȣǾǓǿȠǓǏ� ƺș� ǓАǓǉȠǩΚǓ� ȖǓșȅȣȖǉǓș�
শ�ȅАǾƺǿ� ૭� [ƺΡॹ� �আࢳࢱࢱࢳ ?ȣǠǹǓȖ� ૭� 'ƺȖǾǓȖॹ� �ষঀࢶࢲࢱࢳ
 It is important to note that culture is an import-
ant factor when considering the emotional well-be-
ing, coping, and resources of parents (Cindy-Lee et 
al., 2017; Dunkel Schetter, 2011). The availability 
of resources and reasons for seeking support varies 
across cultures and geographic regions (Baron et al., 
2015; Dunkel Schetter, 2011; Tol et al., 2018), yet 
further knowledge is needed on parent emotional 
processing and use of supports across cultures. Simi-
larly, much of the work on the emotional well-being, 
emotional processing, and subsequent resources for 
prospective parents has been performed with typical 
pregnancies, however, less is known on these top-
ics for those with high-risk pregnancies such as fe-
tal diagnoses. These parents may have unique needs 
and experiences (van der Steen et al., 2016), thus 
further exploration of their emotional process and 
ȠǦǓ� ǟƺǉȠȅȖș� ΛǦǩǉǦ� ǩǿМȣǓǿǉǓ� ȠǦǩș� ȒȖȅǉǓșș� ǩș� ǿǓǓǏǓǏঀ�
 A prenatal diagnosis vastly shifts parents’ per-
spectives of pregnancy (Horsch et al., 2013). Other re-
views have explored this phenomenon, but none have 
focused solely on the emotional processing and accli-
mation of parents who decided to continue their preg-
nancy. Lou and colleagues (2017) completed a thor-
ough review of parent responses to prenatal diagnosis 
that included studies with both continued and ter-
minated pregnancies. Johnson and colleagues (2020) 
performed a comprehensive review of prospective par-
ǓǿȠșঢ়�ΚǩǓΛș�ΛǦǓǿ�ƺ�ǟǓȠƺǹ�ƺǈǿȅȖǾƺǹǩȠΡ�Λƺș�ǩǏǓǿȠǩЙǓǏ�ǈȣȠ�
focused solely on anomalies detected via ultrasound 
and included insights from healthcare professionals. 
� XȖǩȅȖ� ȖǓΚǩǓΛș� ȅАǓȖ� ǩǾȒȅȖȠƺǿȠ� ǩǿșǩǠǦȠș� ȅǿ� ȒƺȖ-
ents and prenatal diagnosis, but additional work is 
ǿǓǓǏǓǏ�ȅǿ� ȠǦǓ�ȒșΡǉǦȅǹȅǠǩǉƺǹ� șȠƺȠǓ� ƺǿǏ� ǓΠȠǓȖǿƺǹ� ǩǿМȣ-
ences for parents who continue these pregnancies to 

GASPAR



33

PARENT PSYCHOLOGICAL ADAPTATION

better understand parents of infants with atypical 
development. As such, the present systematic review 
aimed to synthesize the prenatal emotional adjust-
ment of parents who continued pregnancy after re-
ǉǓǩΚǩǿǠ�ƺ� ǟǓȠƺǹ�ǏǩƺǠǿȅșǩș�ƺǿǏ� Ƞȅ� ǩǏǓǿȠǩǟΡ� ǟƺǉȠȅȖș� ǩǿМȣ-
encing their emotional responses to the diagnosis.

Methods
Search Procedures
 This review was conducted in accordance with 
the Preferred Reporting Items for Systematic Re-
ΚǩǓΛș� ƺǿǏ� EǓȠƺ৉�ǿƺǹΡșǓș� শX[2^E�ষ� ǠȣǩǏǓǹǩǿǓșঀ�
The search strategy utilized SPIDER, a search tool 
for qualitative research (Cooke et al., 2012). SPI-
��[� ǩǏǓǿȠǩЙǓș� ȠǦǓ� শ^ষ� șƺǾȒǹǓ� șȠȣǏǩǓǏ� শ৚ȒƺȖǓǿȠșॹ�
prospective parents”), (PI) phenomenon of inter-
est (“prenatal diagnosis, prospective pregnancy”), 
(D) targeted study design (“interview, survey”), (E) 
evaluation of the phenomenon (“experiences, per-
ceptions”), and (R) type of research (“qualitative”).  

Inclusion Criteria
 Included studies were peer-reviewed original 
empirical works from any country that focused on 
the experiences of current or prospective parents 
(e.g., mother, father, familial caregivers) who con-
tinued their pregnancy after receiving a fetal diagno-
sis. Included studies focused on the prenatal period 
during and after the diagnosis, but prior to birth. If 
studies included both pre- and post-natal diagnoses, 
only prenatal data was used. Fetal diagnosis was con-
ceptualized as an abnormality which would impact 
the child’s post-birth functioning, development, or 
health. Parents were conceptualized as any primary 
caregiver of the child in the perinatal period. Studies 
needed to utilize parent-reported qualitative data (e.g., 
solely qualitative articles or qualitative sections of arti-
cles using mixed methods) and be written in English. 

Exclusion Criteria
 Studies were excluded if they used solely quantita-
tive methods or were not published in a peer-reviewed 
journal. Studies with quantitative data were excluded 
from the present review as the focus was to provide an 
in-depth synthesis of parent experiences and emotions, 
a level of depth often better captured by qualitative 
data as it highlights lived experiences of participants 
while quantitative approaches aim to quantify and or-

der participant data (Ponterotto, 2002).     Studies with 
samples that included only stakeholders and no pri-
mary caregivers were excluded. Studies that included 
parent perspectives of terminated or miscarried preg-
nancies, or postnatally administered diagnoses, were 
also excluded. Studies were excluded that only focused 
on parents’ postnatal experiences, or only detailed par-
ǓǿȠșঢ়�ȒȖǓǿƺȠƺǹ�ǓΠȒǓȖǩǓǿǉǓș�ȒȖǩȅȖ�Ƞȅ�ƺǿ�ȅГǉǩƺǹ�ǏǩƺǠǿȅșǩșঀ�

Study Selection
 Study selection is summarized in Table 1. The 
selection process consisted of two stages. First, data-
bases were searched using search terms and screened 
based on titles and abstracts. Next, full texts of el-
igible studies were read and eligibility criteria were 
applied, resulting in the inclusion of ten publica-
tions. A manual search of reference lists and library 
ȖǓșȅȣȖǉǓș� ǩǏǓǿȠǩЙǓǏ� ǟȅȣȖ� ǾȅȖǓ� ǓǹǩǠǩǈǹǓ� ȒƺȒǓȖșॹ� ȖǓ-
sulting in the inclusion of 14 total publications.

Quality Appraisal
 Methodological quality of included studies was 
assessed by the author using the Critical Appraisal 
Skills Programme (CASP) qualitative appraisal tool 
(Critical Appraisal Skills Programme, 2018). The 
CASP tool evaluates based on criteria from three 
sections consisting of a total of ten items: A) Are the 
results of the study valid? (e.g., items 1) Was there a 
clear statement of the aims of the research? 2) Is a qual-
itative methodology appropriate? 3) Was the research 
design appropriate to address the aims of the research? 
4) Was the recruitment strategy appropriate to the 
aims of the research? 5) Was the data collected in a way 
that addressed the research issue? 6) Has the relation-
ship between the researcher and participants been ad-
equately considered?), B) What are the results? (e.g., 
items 7) Have ethical issues been taken into consider-
ƺȠǩȅǿঁ� �ষ�vƺșࢹ ȠǦǓ� ǏƺȠƺ� ƺǿƺǹΡșǩș� șȣГǉǩǓǿȠǹΡ� ȖǩǠȅȖȅȣșঁ�
�ষ�2ș�ȠǦǓȖǓ�ƺ�ǉǹǓƺȖ�șȠƺȠǓǾǓǿȠ�ȅǟ�ЙǿǏǩǿǠșঁষॹ�ƺǿǏ��ষ�vǩǹǹࢺ
the results help locally? (e.g., item 10) How valuable 
is the research?). Each item was rated Yes, Can’t Tell, 
or No. After rating, each item was assigned a point 
value (i.e., Yes = 2, Can’t Tell = 1, No = 0) and items 
were totaled with 20 as the maximum possible score. 
Studies receiving a score of 17 or higher were classi-
ЙǓǏ� ƺș� ǦǩǠǦ� ǾǓȠǦȅǏȅǹȅǠǩǉƺǹ� ȕȣƺǹǩȠΡॹ� șǉȅȖǓș� ǈǓȠΛǓǓǿ�
16 and 14 as moderate methodological quality, and 
13 or below as lesser methodological quality. No stud



34

ies were excluded because of the appraisal (Table 1).

Data Synthesis 
 This review utilized thematic analysis (Thomas & 
Harden, 2008) which allowed results of the included 
ȒȣǈǹǩǉƺȠǩȅǿș�Ƞȅ�ǈǓ�șΡǿȠǦǓșǩΦǓǏঀ�^ȒǓǉǩЙǉƺǹǹΡॹ�ȠǦǓ�ƺǿƺǹΡ-
sis procedures employed a thematic synthesis approach 
outlined by Thomas and Harden (2008) which allows 
ǟȅȖ�ƺǿ�ǓАǓǉȠǩΚǓ�ȠȖƺǿșǹƺȠǩȅǿ�ȅǟ�ǉȅǿǉǓȒȠș�ƺǿǏ�ǉȅǿǿǓǉȠǩȅǿ�
ȅǟ�ȕȣƺǹǩȠƺȠǩΚǓ�ȖǓșǓƺȖǉǦ�ЙǿǏǩǿǠșঀ�eǦǓ�ȠǦǓǾƺȠǩǉ�șΡǿȠǦǓșǩș�
guidelines were used to generate and identify themes 
and subthemes. First, included studies were read mul-
tiple times and notes were taken of initial ideas for 
coding. Next, the qualitative results sections of each 
study were reviewed and coded into a set of initial, 
broad codes. Data relevant to each code was extracted 
and sorted under the respective code. Codes were in-
ductively developed and added to as needed, resulting 
in a set of overarching themes (e.g., initial reactions, 
processing period, social factors, and coping strat-
ǓǠǩǓșষ�ΛǦǩǉǦ�ΛǓȖǓ� ǉǦǓǉǷǓǏ� ǟȅȖ�ЙȠ�ΛǩȠǦ� ȠǦǓ�ǏƺȠƺ� ȠǦǓǿ�
ǏǓЙǿǓǏ�ƺǿǏ�ǿƺǾǓǏঀ�'ȖȅǾ�ǦǓȖǓॹ�ǏƺȠƺ�ȣǿǏǓȖ�ǓƺǉǦ�ȠǦǓǾǓ�
was reviewed and sorted further into narrower sub-
themes under each broader theme. Subthemes were 
ȖǓΚǩǓΛǓǏ�ƺǿǏ�ȖǓЙǿǓǏ�ǟȅȖ�ЙȠ�ΛǩȠǦǩǿ�ȠǦǓ�ǈȖȅƺǏǓȖ�ȠǦǓǾǓșঀ

Results
 The 14 included studies were conducted in a range 
ȅǟ�ǉȅȣǿȠȖǩǓșॸ�ЙΚǓ� ǟȖȅǾ�ȠǦǓ�hǿǩȠǓǏ�^ȠƺȠǓșॹ� ȠǦȖǓǓ� ǟȖȅǾ�
Australia, two from Sweden, one from Denmark, one 
from Ireland, one from South Korea, and one from 
the United Kingdom. The studies included a total of 
251 primary caregivers, including 173 mothers, 67 fa-
thers, nine grandparents, and two undisclosed sexes. 
While included studies varied in aims, qualitative de-
sign, and distinct focus, all examined parents’ insight 
and experiences after receiving a prenatal diagnosis.
 Based on the thematic analysis (Thomas & Hard-
en, 2008), the synthesized results show that emotional 
adjustment to a fetal diagnosis was an ongoing process 
characterized by two main timepoints: initial diagno-
sis and processing period. Table 2 details a summary 
of themes and corresponding studies. Parents experi-
ǓǿǉǓǏ� ǏǩАǓȖǓǿȠ� ȒǓȖșȒǓǉȠǩΚǓș� ǏǓȒǓǿǏǩǿǠ� ȅǿ� ȠǦǓ� ȠǩǾǓ-
point. They reported early emotions at the time of 
diagnosis, then shifted emotions as they underwent 
the processing period. While families consistently re-
acted strongly to the initial diagnosis, these emotions 

were not homogenous and shifted as parents adjust-
ed to the news. Individual parent experiences of the 
ȅΚǓȖƺǹǹ� ƺǏǴȣșȠǾǓǿȠ� ȒȖȅǉǓșș� ΛǓȖǓ� ǩǿМȣǓǿǉǓǏ� ǈΡ� ȠΛȅ�
main factors: interactions with others and coping 
strategies. Figure 2 models parents’ emotional process.
 Initial Reactions. Parents reported a range of 
ǓǾȅȠǩȅǿș� ΛǦǓǿ� ȠǦǓΡ� ЙȖșȠ� ȖǓǉǓǩΚǓǏ� ȠǦǓ� ǟǓȠƺǹ� ǏǩƺǠǿȅ-
sis. Most parents described intense shock when they 
received the news (Carlsson et al., 2017; Clark et al., 
�আ�(ȅАࢲࢲࢱࢳ�আ��ȈȠǔে�ȖșǓǿƺȣǹȠ�૭��ǓǿǿǓΡে?ȅǓǹșǉǦॹࢱࢳࢱࢳ
et al., 2013; Hickerton et al., 2011; How et al., 2019; 
Im et al., 2018; Johnson et al., 2018; Lokmic et al., 
2017; McKechnie & Pridham, 2012; O’Connell et al., 
�ষ�ƺǿǏ�ǏǓșǉȖǩǈǓǏ�ǦȅΛ�ȠǦǩș�șǦȅǉǷ�ǾƺǏǓ�ǩȠ�ǏǩГǉȣǹȠࢺࢲࢱࢳ
to grasp the diagnosis (Carlsson et al., 2017). Shock 
Λƺș� ǓșȒǓǉǩƺǹǹΡ� șƺǹǩǓǿȠ� ǩǿ� ЙȖșȠেȠǩǾǓ� ǾȅȠǦǓȖș� শKঢ়�ȅǿ-
nell et al., 2019). Parents also reported grief, sadness, 
and mourning (Carlsson et al., 2015; Carlsson et 
al., 2017; Clark et al., 2020; Côté-Arsenault & Den-
ney-Koelsch, 2011; Hickerton et al., 2011; How et al., 
2019; Im et al., 2018; Johnson et al., 2018; Lou et al., 
2020; McKechnie & Pridham, 2012; McKechnie et al., 
2015; O’Connell et al., 2019). They described intense 
ǓǾȅȠǩȅǿƺǹ� șȣАǓȖǩǿǠ� ƺǿǏ� ǏǓΚƺșȠƺȠǩȅǿ� শ�ƺȖǹșșȅǿ� ǓȠ� ƺǹঀॹ�
2015; Clark et al., 2020; Im et al., 2018; McKechnie & 
Pridham, 2012; O’Connell et al., 2019), and felt a deep 
sense of loss surrounding their original expectations 
for the child and pregnancy (Côté-Arsenault & Den-
ney-Koelsch, 2011; Hickerton et al., 2011; Johnson 
et al., 2018; Lou et al., 2020; McKechnie et al., 2015). 
� �� ȒȅȖȠǩȅǿ� ȅǟ� ȒƺȖǓǿȠș� ǟǓǹȠ� ƺǿǠǓȖ� ΛǦǓǿ� ȠǦǓΡ� ЙȖșȠ�
ǦǓƺȖǏ�ȠǦǓ�ǏǩƺǠǿȅșǩș�শ�ƺȖǹșșȅǿ�ǓȠ�ƺǹঀॹࢸࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹ�
2013) while others felt confused (Carlsson et al., 2015; 
Hickerton et al., 2011; Im et al., 2018; McKechnie & 
XȖǩǏǦƺǾॹ� �ষঀࢶࢲࢱࢳ eǦǓΡ� ȕȣǓșȠǩȅǿǓǏ� ΛǦΡ� শ(ȅА� ǓȠ� ƺǹঀॹ�
2013; McKechnie & Pridham, 2012) and felt the diag-
nosis did not make sense (Carlsson et al., 2015; Im et 
al., 2018). Many parents also reported fear and anxiety 
(Carlsson et al., 2015; Im et al., 2018; Johnson et al., 
2018; Lokmic et al., 2017; Lou et al., 2020; McKech-
nie et al., 2015). Some were fearful of fetal loss or wors-
ening of the condition (Carlsson et al., 2015; McKech-
nie et al., 2015), while others experienced panic about 
the future (Im et al., 2018; Lou et al., 2020). Parents 
also reported feelings of guilt (Carlsson et al., 2017; 
Clark et al., 2020; Côté-Arsenault & Denney-Koelsch, 
2011; Hickerton et al., 2011; Im et al., 2018; Lokmic 
et al., 2017). Many felt guilt for potentially causing the 

GASPAR



35

PARENT PSYCHOLOGICAL ADAPTATION

anomaly (Carlsson et al., 2017; Côté-Arsenault & Den-
ney-Koelsch, 2011; Lokmic et al., 2017), while others 
felt moral guilt in considering whether to terminate 
the pregnancy (Im et al., 2018; Hickerton et al., 2011). 
For some parents, guilt was compounded with other 
emotions, like guilt about their sadness or hope for a 
false-positive diagnosis (Carlsson et al., 2017; Clark et 
al., 2020; Côté-Arsenault & Denney-Koelsch, 2011).
 Overall Trends during the Processing Period.
Adjusting to the diagnosis was a process for parents. 
They overwhelmingly reported gratitude in receiving 
the diagnosis prenatally versus postnatally (Carlsson 
et al., 2015; Carlsson et al., 2017; Clark et al., 2020; 
�ȈȠǔে�ȖșǓǿƺȣǹȠ�૭��ǓǿǿǓΡে?ȅǓǹșǉǦॹࢲࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹ�
2013; Hickerton et al., 2011; How et al., 2019; Im et 
al., 2018; Johnson et al., 2018; Lokmic et al., 2017; 
Lou et al., 2020; McKechnie & Pridham, 2012; McK-
echnie et al., 2015; O’Connell et al., 2019) as this gave 
them time to prepare. However, after receiving the 
diagnosis, parents felt they needed time to digest the 
ǿǓΛș�শ�ǹƺȖǷ�ǓȠ�ƺǹঀॹࢱࢳࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢴࢲࢱࢳ�আ�/ȅΛ�ǓȠ�ƺǹঀॹ�
2019; McKechnie & Pridham, 2012). In this process-
ing period, they shifted their thoughts and feelings to-
ward the future (Carlsson et al., 2015; Carlsson et al., 
�আ�/ǩǉǷǓȖȠȅǿࢴࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢱࢳࢱࢳ�আ��ǹƺȖǷ�ǓȠ�ƺǹঀॹࢸࢲࢱࢳ
et al., 2011; How et al., 2019; Im et al., 2018; Johnson 
et al., 2018; Lou et al., 2020; McKechnie & Pridham, 
2012; McKechnie et al., 2015). As they looked ahead, 
most described an acceptance of the diagnosis (Carls-
son et al., 2015; Carlsson et al., 2017; Clark et al., 
�আ�/ȅΛࢲࢲࢱࢳ�আ�/ǩǉǷǓȖȠȅǿ�ǓȠ�ƺǹঀॹࢴࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢱࢳࢱࢳ
et al., 2019; Im et al., 2018; Lou et al., 2020; McKech-
nie & Pridham, 2012; McKechnie et al., 2015). Many 
felt having time to process emotions helped their ac-
ǉǓȒȠƺǿǉǓ� শ�ǹƺȖǷ� ǓȠ� ƺǹঀॹ� �আ�/ȅΛࢱࢳࢱࢳ ǓȠ� ƺǹঀॹ� �আ�(ȅАࢺࢲࢱࢳ
et al., 2013; McKechnie & Pridham, 2012), and used 
this time to reframe their original expectations of the 
child, future parenting, and life milestones (Hickerton 
et al., 2011; McKechnie et al., 2015). Parents began to 
celebrate and see their unborn baby as any other child, 
with individuality, personality, and hardships that all 
ȒƺȖǓǿȠș� ǟƺǉǓ� শ(ȅА�ǓȠ� ƺǹঀॹ� �আ�/ȅΛ�ǓȠࢴࢲࢱࢳ ƺǹঀॹ� �আࢺࢲࢱࢳ 2Ǿ�
et al., 2018; Lou et al., 2020; McKechnie et al., 2015).
 Despite acceptance of their future child and cir-
cumstances, most parents reported ongoing anxieties 
during the processing period (Carlsson et al., 2015; 
�ƺȖǹșșȅǿ� ǓȠ� ƺǹঀॹ� �আ��ǹƺȖǷࢸࢲࢱࢳ ǓȠ� ƺǹঀॹ� �আ�(ȅАࢱࢳࢱࢳ ǓȠ� ƺǹঀॹ�
2013; Hickerton et al., 2011; How et al., 2019; Im et 

al., 2018; Johnson et al., 2018; Lou et al., 2020; McK-
echnie & Pridham, 2012; McKechnie et al., 2015; 
O’Connell et al., 2019). Worries focused on the cur-
rent pregnancy and the remaining gestational develop-
ment of their child (Carlsson et al., 2017; How et al., 
2019; Lou et al., 2020; McKechnie & Pridham, 2012; 
McKechnie et al., 2015). Other fears revolved around 
the future. Parents were uncertain about the outlook 
for themselves and their child (Carlsson et al., 2015; 
�ƺȖǹșșȅǿ� ǓȠ� ƺǹঀॹ� �আ��ǹƺȖǷࢸࢲࢱࢳ ǓȠ� ƺǹঀॹ� �আ�(ȅАࢱࢳࢱࢳ ǓȠ� ƺǹঀॹ�
Hickerton et al., 2011; 2013; Johnson et al., 2018; Lou 
et al., 2020; McKechnie & Pridham, 2012; McKechnie 
et al., 2015). They worried about navigating the new 
ǩǿМȣΠ� ȅǟ� ǩǿǟȅȖǾƺȠǩȅǿ� ƺǿǏ� ǾǓǓȠǩǿǠ� ȠǦǓǩȖ� ǉǦǩǹǏঢ়ș� ǟȣ-
ture needs, such as medical and other support services 
(Carlsson et al., 2017; Clark et al., 2020; McKechnie 
& Pridham, 2012; McKechnie et al., 2015). Many felt 
societal pressures such as the expectation to produce 
a healthy child (Im et al., 2018), the impact of a child 
with a disability on family functioning (Carlsson et al., 
�আ�@ȅȣ�ǓȠࢴࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢸࢲࢱࢳ�আ��ƺȖǹșșȅǿ�ǓȠ�ƺǹঀॹࢶࢲࢱࢳ
al., 2020), and their child’s future social experiences 
including stigma and social milestones (Clark et al., 
2020; Johnson et al., 2018; Lou et al., 2020; McKech-
nie et al., 2015). Parents also reported uncertainty in 
their social functioning, especially when interacting 
ΛǩȠǦ�ȒƺȖǓǿȠș�ȅǟ� ȠΡȒǩǉƺǹǹΡ�ǏǓΚǓǹȅȒǓǏ�ǉǦǩǹǏȖǓǿ�শ(ȅА�ǓȠ�
al., 2013; Hickerton et al., 2011; Johnson et al., 2018).
 Though anxious, parents reported a newfound 
bond with their unborn child (Carlsson et al., 2017; 
Côté-Arsenault & Denney-Koelsch, 2011; Im et al., 
2018; Lou et al., 2020; McKechnie et al., 2015; O’Con-
nell et al., 2019). As they accepted their child, they de-
scribed a strong sense of love and attachment and felt an 
increasing connection that strengthened their parental 
duty and commitment (Carlsson et al., 2017; Im et al., 
2018; Lou et al., 2020; McKechnie et al., 2015; O’Con-
nell et al., 2019). They saw their baby as an individual, 
and desired for others to view their child the same way 
(Côté-Arsenault & Denney-Koelsch, 2011; How et 
al., 2019; Im et al., 2018; O’Connell et al., 2018). Filled 
with acceptance and love, parents reported feelings of 
positivity and hope as they progressed through the 
pregnancy (Clark et al., 2020; Im et al., 2018; McK-
echnie & Pridham, 2012; McKechnie et al., 2015). 
� 2ǿМȣǓǿǉǩǿǠ� ǟƺǉȠȅȖș. Despite consistent over-
all trends, parents did not all follow the same rate of 
adjustment during the processing period. Some had 



36

a slower adjustment and others rebounded from the 
ǏǩƺǠǿȅșǩș�ȕȣǩǉǷǹΡঀ�^ȅǾǓ�ǦƺǏ�ƺ�ȒȅșǩȠǩΚǓॹ�ǟȣǹЙǹǹǩǿǠ�ȒȖǓǠ-
nancy, while others felt more cynical and distanced. 
Emergent themes evidenced that experiences were 
shaped by outside factors. Throughout included stud-
ies, parents mentioned multifaceted details in social 
interactions and coping strategies which contributed 
to their pregnancy experience and acclimation process. 

Social Interactions with Others
 Medical Professionals. Medical professionals 
ranged from doctors, nurses, doulas, and other preg-
ǿƺǿǉΡ� șȣȒȒȅȖȠ� șȠƺАঀ� ^ȅǾǓ� ȒƺȖǓǿȠș� ǏǓΚǓǹȅȒǓǏ� ǉǹȅșǓ�
relationships with their healthcare professionals and 
communicated with them frequently after receiving 
the diagnosis (McKechnie & Pridham, 2012; McKech-
nie et al., 2015). These parents had a select few which 
they trusted and looked to for support (Carlsson et al., 
�আ�@ȅȣ�ǓȠࢲࢲࢱࢳ�আ�/ǩǉǷǓȖȠȅǿ�ǓȠ�ƺǹঀॹࢴࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢶࢲࢱࢳ
al., 2020). They appreciated their knowledge and ad-
vice relating to the pregnancy and diagnosis (Carlsson 
et al., 2015; Côté-Arsenault & Denney-Koelsch, 2011, 
Hickerton et al., 2011; How et al., 2019; Im et al., 2018; 
McKechnie et al., 2015; O’Connell et al., 2019). Par-
ǓǿȠș�ΛǓȖǓ�ǓșȒǓǉǩƺǹǹΡ�șƺȠǩșЙǓǏ�ΛǦǓǿ�ǾǓǏǩǉƺǹ�ȒȖȅǟǓșșǩȅǿ-
als listened and supported their decisions and felt most 
at ease getting continuous care from their trusted team 
(Carlsson et al., 2015; Hickerton et al., Lou et al., 2020). 
 However, many parents in included studies over-
whelmingly reported negative experiences with med-
ical professionals after the diagnosis. They reported 
that healthcare professionals had pessimistic attitudes 
and delivered diagnostic news poorly (Carlsson et 
al., 2015; Clark et al., 2020; Côté-Arsenault & Den-
ǿǓΡে?ȅǓǹșǉǦॹ� �আࢲࢲࢱࢳ (ȅА� ǓȠ� ƺǹঀॹ� �আࢴࢲࢱࢳ /ǩǉǷǓȖȠȅǿ� ǓȠ�
al., 2011; Im et al., 2018; Johnson et al., 2018; Lok-
mic et al., 2017; Lou et al., 2020; McKechnie et al., 
2015; O’Connell et al., 2019). Parents felt providers 
held negative stereotypes about disabilities and rou-
tinely pushed for a termination of pregnancy, often 
ǾƺǷǩǿǠ�ȖǓȒǓƺȠǓǏ�ǉȅǾǾǓǿȠș�ƺǈȅȣȠ�ȠǓȖǾǩǿƺȠǩȅǿ�শ(ȅА�
et al., 2013; Hickerton et al., 2011; How et al., 2018; 
Johnson et al., 2018; Lokmic et al., 2017; Lou et al., 
2020). Many parents described medical professionals 
as grim, unemotional, and uncompassionate in their 
ǉƺȖǓ� শ�ǹƺȖǷ� ǓȠ� ƺǹঀॹ� �আ�(ȅА�ǓȠࢱࢳࢱࢳ ƺǹঀॹ� �আ�@ȅȣ�ǓȠࢴࢲࢱࢳ ƺǹঀॹ�
2020), and recounted hurtful, inappropriate remarks 
from providers about their babies and choices (John-

son et al., 2018; McKechnie et al., 2015; O’Connell et 
al., 2019). Parents felt the professionals lacked crucial 
knowledge and resources about the diagnoses and were 
inconsistent in the advice and information they shared 
(Carlsson et al., 2015; Carlsson et al., 2017; Côté-Arse-
ǿƺȣǹȠ�૭��ǓǿǿǓΡে?ȅǓǹșǉǦॹࢲࢲࢱࢳ�আ�(ȅА�ǓȠ�ƺǹঀॹࢴࢲࢱࢳ�আ�=ȅǦǿ-
son et al., 2018; Lokmic et al., 2017; Lou et al., 2020). 
Often, unannounced specialists attended appoint-
ments, which made parents increasingly anxious and 
distrustful (Johnson et al., 2018; Lokmic et al., 2017). 
 Friends and Family. Family and friends ranged 
from immediate and extended family to circles of 
friends. Parents’ social networks were important 
sources of support during the pregnancy (Carls-
son et al., 2017; Clark et al., 2020; Côté-Arsenault 
૭� �ǓǿǿǓΡে?ȅǓǹșǉǦॹ� �আࢲࢲࢱࢳ (ȅА� ǓȠ� ƺǹঀॹ� �আࢴࢲࢱࢳ /ǩǉǷ-
erton et al., 2011; McKechnie & Pridham, 2012; 
McKechnie et al., 2015; O’Connell et al., 2019). 
Parents retreated to their trusted, inner social circles 
after the diagnosis (Clark et al., 2020; McKechnie 
& Pridham, 2012; O’Connell et al., 2019), and re-
lied on them to listen and help with practical needs 
(Carlsson et al., 2017; McKechnie & Pridham, 2012). 
 However, not all of the parents’ social groups were 
accepting or helpful (Carlsson et al., 2017; Clark et al., 
2020; Côté-Arsenault & Denney-Koelsch, 2011; Hick-
erton et al., 2011; How et al., 2019; McKechnie et al., 
2015; O’Connell et al., 2019). Parents felt family and 
friends were not always supportive (Côté-Arsenault & 
Denney-Koelsch, 2011; Hickerton et al., 2011; McKe-
chnie et al., 2015). Parents received insensitive remarks 
and felt pressured by others to terminate the pregnancy 
(Hickerton et al., 2011; How et al., 2019; O’Connell 
et al., 2019). Many friends and family members were 
unsure how to respond to the diagnosis, while others 
refused to accept the pregnancy or unborn baby (Clark 
et al., 2020; Côté-Arsenault & Denney-Koelsch, 2011; 
Hickerton et al., 2011). Parents felt lonely, isolated, 
and stigmatized, and felt others could no longer relate 
to them (Côté-Arsenault & Denney-Koelsch, 2011; 
McKechnie et al., 2015, O’Connell et al., 2019). They 
underwent a great divide in their personal and social 
experiences and reported the distancing and changing 
of friendships (Carlsson et al., 2017; Côté-Arsenault 
& Denney-Koelsch, 2011; McKechnie et al., 2015).

GASPAR



37

Parents’ Coping Strategies
 Research and Information-Gathering. Most 
ȒƺȖǓǿȠș�ǟǓǹȠ�ƺ�ǿǓǓǏ�Ƞȅ�ЙǿǏ�ǩǿǟȅȖǾƺȠǩȅǿ�ȅǿ�ȠǦǓ�ǏǩƺǠǿȅ-
sis, which they did through personal research. They 
tried to educate themselves and build their knowledge 
as much as possible so they could be prepared for the 
future (Carlsson et al., 2015; Carlsson et al., 2017; 
Clark et al., 2020; Im et al., 2018; Johnson et al., 2018; 
Lokmic et al., 2017; Lou et al., 2020; McKechnie & 
Pridham, 2012; McKechnie et al., 2015; O’Connell 
et al., 2019). Some found this strategy helpful and at-
tained valuable information on their baby’s condition 
(Carlsson et al., 2015; Im et al., 2018; Lou et al., 2020; 
McKechnie & Pridham, 2012), while others found it 
overwhelming and confusing due to the large quantity 
of resources, much of it negative or outdated (Carls-
son et al., 2015; Clark et al., 2020; Lokmic et al., 2017; 
McKechnie & Pridham, 2012; McKechnie et al., 2015).
 Experiential Knowledge. Parents also relied on 
the experiences of other families with the same diag-
noses. Some parents connected with these families 
ȠǦȖȅȣǠǦ� ȠǦǓǩȖ� ȖǓșǓƺȖǉǦ� ǓАȅȖȠșॹ� ΛǦǩǹǓ� ȅȠǦǓȖș� ȖǓƺǉǦǓǏ�
out to families they already knew. For some, the expe-
riences of others caused fear and distress, especially in 
cases with poor outcomes (Carlsson et al., 2015; Carls-
son et al., 2017; McKechnie et al., 2015). But for many, 
the experiences of other parents helped them feel pos-
itive and reassured (Clark et al., 2020; Johnson et al., 
2018; Lokmic et al., 2017; McKechnie & Pridham, 
2012; McKechnie et al., 2015; O’Connell et al., 2019). 
Collaborating with others lessened their anxiety and 
reshaped expectations, especially when they saw chil-
dren with similar conditions living happy lives (How 
et al., 2019; Johnson et al., 2018). Some parents also 
joined parent groups and disability organizations to 
extend their social support (Johnson et al., 2018; McK-
echnie & Pridham, 2012; McKechnie et al., 2015). 
 Healthcare Planning. Parents also took com-
fort in planning for the future. They focused on the 
logistical health consequences of the diagnosis, joined 
healthcare waitlists, and planned postnatal care so they 
could be actively involved in upcoming healthcare 
decisions (Carlsson et al., 2015; Johnson et al., 2018; 
McKechnie & Pridham, 2012; McKechnie et al., 
�ষঀ�KȠǦǓȖșࢶࢲࢱࢳ ȖǓМǓǉȠǓǏ� ȅǿ� ȠǦǓǩȖ� ȒǓȖșȅǿƺǹ� ǦǓƺǹȠǦ� ƺǿǏ�
began eating better and exercising (Im et al., 2018).
 Perspective-Taking. As another strategy, par-
ents reexamined their perspectives of the diagnosis. 

Some utilized religion and began to view their baby as 
ƺ�ǈǹǓșșǩǿǠ�ǟȖȅǾ�ƺ�ǦǩǠǦǓȖ�ȒȅΛǓȖ�শ(ȅА�ǓȠ�ƺǹঀॹࢴࢲࢱࢳ�আ�2Ǿ�
et al., 2013), while others actively worked to change 
their idealized future to better align with the diagno-
sis (Clark et al., 2020; How et al., 2019; McKechnie 
et al., 2015). These parents emphasized gaining rath-
er than losing and focused on the essential responsi-
bility of raising the child, identifying themselves as 
parents and embracing their parental role (How et 
al., 2019; Lou et al., 2020; McKechnie et al., 2015).

Discussion
 This systematic review of 14 qualitative studies ex-
plored the psychological processes of prospective par-
ents after receiving a fetal diagnosis. The review found 
that receiving a prenatal diagnosis marks a multiplex 
adjustment period for parents and adds an unexpected 
psychological burden as they absorb the news. At the 
initial diagnosis, parents often experienced mourning 
and shock. Past work suggests that these reactions are 
common for parents, and they are not alone in these 
feelings (Staham et al., 2000) as the initial diagnosis 
is the most emotionally challenging time for parents 
শ�ǦƺȒǹǩǿ�ǓȠ�ƺǹঀॹࢶࢱࢱࢳ�ষঀ��ǓΡȅǿǏ�ȠǦǓ�ЙȖșȠ�ǏǩƺǠǿȅșǩșॹ�ȒƺȖ-
ents in the present review progressed through a multi-
ǟƺǉǓȠǓǏ�ƺǏǴȣșȠǾǓǿȠ�ȒȖȅǉǓșș�ЙǹǹǓǏ�ΛǩȠǦ�ǏΡǿƺǾǩǉॹ�ǉȅǾ-
plicated emotions. Consistent with prior work, parents 
ǩǿ� ȠǦǓ� ȒȖǓșǓǿȠ� ȖǓΚǩǓΛ� ǏǩАǓȖǓǏ� ǩǿ� ȒȖȅǉǓșșǩǿǠ� ȠǩǾǓ� ƺș�
they accepted the child as an individual (Chaplin et 
al., 2005; Lou et al., 2017) and oriented themselves 
to how the diagnosis shaped their present and future 
(Johnson et al., 2020; Statham et al., 2000). Outside 
factors including social support and coping strategies 
ǩǿМȣǓǿǉǓǏ�ȒƺȖǓǿȠșঢ়�ǩǿǏǩΚǩǏȣƺǹ�ƺǏǴȣșȠǾǓǿȠ�ȠȖƺǴǓǉȠȅȖǩǓșঀ�
 A mental shift is common for prospective par-
ents. Past work has shown that the transition to 
parenthood lowers new parents’ psychological 
well-being, even for those with typically develop 
pregnancies and high self-esteem prior to becom-
ing a parent (Chen et al., 2020). However, parents 
who receive a fetal diagnosis are at an especially in-
creased mental health risk (Cole et al., 2016) as they 
shift their mindsets and prepare for the future.
 Given the emotional adjustment occurring in 
ȠǦǓșǓ� ȒȖǓǠǿƺǿǉǩǓș� ƺǿǏ� ȠǦǓ� ǩǿМȣǓǿǉǓ� ȅǟ� ǓΠȠǓȖǿƺǹ� ǟƺǉ-
tors documented in the present review, parents may 
ǈǓǿǓЙȠ� ǟȖȅǾ� ƺȒȒȖȅȒȖǩƺȠǓ� ǉƺȖǓ� ƺǿǏ� șȣȒȒȅȖȠ� ǏȣȖǩǿǠ�
ȠǦǩș� ȒǓȖǩȅǏ� Ƞȅ� ǈȅȅșȠ� ȒȅșǩȠǩΚǓ� ǩǿМȣǓǿǉǩǿǠ� ǟƺǉȠȅȖș�

PARENT PSYCHOLOGICAL ADAPTATION



3838

GASPAR

the present review. Strengthening protective fac-
tors in this population is especially imperative as 
parents may be at risk for long-term psychological 
distress as children born with a fetal abnormali-
ty have an increased risk of altered developmental 
outcomes and disabilities throughout their lifes-
pan (Liu et al., 2016; Love et al., 2011) and parents 
of children with disabilities often show decreased 
psychological health (Olsson & Hwang, 2008).
 One possibility for a reinforced protective support 
is through healthcare providers. The present review 
and past literature show that parents with fetal diag-
noses often experience negative, insensitive, and unin-
formed medical care (Chaplin et al., 2005; Stock et al., 
2019), but literature suggests that healthcare providers 
may be ill-prepared and receive little training in parent 
practices post-diagnosis (Johnson et al., 2020; Luz et al., 
2017). Despite this, parents strongly rely on and desire 
genuine, trusting relationships with their healthcare 
team (Oulton et al., 2020), and parents in the present 
review who received supportive care from their health-
care team felt more comfortable and prepared. To ad-
dress gaps in provider quality, health organizations may 
want to consider updating and expanding parent re-
sources and encourage healthcare professionals to par-
take in additional professional development and train-
ing on parent support practices and fetal abnormalities 
to better support families in the perinatal period. 
 As evidenced in the present review and pri-
ȅȖ� ΛȅȖǷ� শ�ȅАǾƺǿ� ૭� [ƺΡॹ� �আࢳࢱࢱࢳ ?ȣǠǹǓȖ� ૭� 'ƺȖǾǓȖॹ�
�ষॹࢶࢲࢱࢳ ȠƺȖǠǓȠǓǏ� șȅǉǩƺǹ� ǿǓȠΛȅȖǷș� ƺǹșȅ� ȅАǓȖ� ƺ� ȒȖȅǾǩș-
ing route for a bolstered protective role. In addition 
Ƞȅ� ȒƺȖǓǿȠșঢ়� ǩǾǾǓǏǩƺȠǓ� șȅǉǩƺǹ� ǉǩȖǉǹǓșॹ� ЙǿǏǩǿǠș� șȣǠǠǓșȠ�
advantages to participation in formal social outlets 
such as support groups, especially those with sim-
ilar perinatal experiences. Parents in past literature 
who participated in parent groups described these 
relationships as imperative for their adjustment to 
parenthood as it provided a space to discuss their 
shared experiences and challenges with new parenting 
(Glavin et al., 2017). Parents who receive fetal diag-
ǿȅșǓș�ǾƺΡ�ǈǓǿǓЙȠ� ǟȖȅǾ� șȣǉǦ� șȅǉǩƺǹ� ȅȒȒȅȖȠȣǿǩȠǩǓș� Ƞȅ�
connect with other families with shared experiences.
 A third, innovative approach to strengthening 
protective factors is the addition of psychological 
professionals to prospective parents’ support teams. 
Literature suggests that parents are best supported 
by a multidisciplinary team of healthcare and psy-

chological professionals (Catlin et al., 2008; Statham 
ǓȠ� ƺǹঀॹ� �ষॹࢱࢱࢱࢳ ƺǿǏ� ƺș� șȣǉǦ� ȒƺȖǓǿȠș� ǾƺΡ� ǈǓǿǓЙȠ� ǟȖȅǾ�
psychological support as they process the diagnosis. 
Recent work on mindfulness interventions (Reid et 
al., 2016), group prenatal care (Ickovics et al., 2019), 
grief support (Navidian et al., 2017), and other psy-
chological counseling (Rohde et al., 2008) indicate 
promising results for perinatal parent populations. 
Pretest counseling has also been demonstrated as 
ǈǓǿǓЙǉǩƺǹ� Ƞȅ� ǦǓǹȒ� ǓǾȅȠǩȅǿƺǹǹΡ� ȒȖǓȒƺȖǓ� ȒƺȖǓǿȠș� ǟȅȖ�
prenatal screening results (Dorner et al., 2020).

Limitations and Conclusion 
 There are some limitations in this review. First, 
ΛǦǩǹǓ�ǓАȅȖȠș�ΛǓȖǓ�ǾƺǏǓ�Ƞȅ�ǉȅǿǏȣǉȠ�ƺ�ȠǦȅȖȅȣǠǦॹ�ǉȅǾ-
prehensive search and selection of literature, addition-
al studies may have been published since the initial 
searches were performed and were not included in 
the present selection. Similarly, the analysis process 
ǾƺΡ�ǏǩАǓȖ�ǈǓȠΛǓǓǿ�ȖǓșǓƺȖǉǦǓȖșঀ��ǹȠǦȅȣǠǦ�ȒȖȅǉǓǏȣȖƺǹ�
steps are detailed, it is possible that others may utilize 
ǏǩАǓȖǓǿȠ� ǉȅǏǩǿǠ� ƺȖȖƺǿǠǓǾǓǿȠș� ƺǿǏ� ǴȣǏǠǓǾǓǿȠșঀ� �Ǐ-
ditionally, although qualitative studies were included 
in the present review, quantitative data may also pro-
vide valuable insights. Future work in this area may 
ΛƺǿȠ� Ƞȅ� ȒǓȖǟȅȖǾ� ƺǿ� ƺǿƺǹΡșǩș� ȅǟ� ȕȣƺǿȠǩȠƺȠǩΚǓ� ЙǿǏǩǿǠș�
or synthesize a combination of both qualitative and 
quantitative literature. Studies in this review covered 
a wide range of countries. It is important to note the 
ǩǿМȣǓǿǉǓ�ȅǟ�ǉȣǹȠȣȖǓ�ǩǿ�ǓƺǉǦ�ȠƺȖǠǓȠ�ȒȅȒȣǹƺȠǩȅǿॹ�ΛǦǩǉǦ�
may shape study results including individual respons-
es, coping, and perspectives. Future reviews may 
ǈǓǿǓЙȠ� ǟȖȅǾ�ǿƺȖȖȅΛǩǿǠ� ȠǦǓ� ǟȅǉȣș� Ƞȅ� ƺ�ǾȅȖǓ�ǦȅǾȅǠ-
enous selection of countries, while further empirical 
work is needed to explore fetal diagnoses and avail-
able resources across cultures and geographic regions. 
 Receiving a fetal diagnosis is life-altering news for 
families. The present review suggests that prospec-
tive parents have similar initial reactions to prenatal 
diagnosis, but the subsequent adjustment process 
ǩș� șǦƺȒǓǏ�ǈΡ� ΚƺȖǩȅȣș� ǩǿМȣǓǿǉǩǿǠ� ǟƺǉȠȅȖș� ƺǿǏ� ǓΠȠǓȖǿƺǹ�
characteristics. Parents who have strong protective 
factors, such as supportive social networks and sensi-
tive, informed healthcare support may have improved 
experiences and adjustment. Findings suggest the ben-
ǓЙȠ� ȅǟ� ȒȖȅΚǩǏǩǿǠ� ǩǾȒȖȅΚǓǏ� ǾǓǏǩǉƺǹॹ� ȒșΡǉǦȅǹȅǠǩǉƺǹॹ�
and social resources to parents after a fetal diagnosis. 
eƺǷǓǿ� ȠȅǠǓȠǦǓȖॹ� ȠǦǓșǓ� ЙǿǏǩǿǠș� ȒȖȅΚǩǏǓ� ǏǓǓȒǓȖ� ȣǿ-



39

PARENT PSYCHOLOGICAL ADAPTATION

derstanding of parent experiences and related factors 
and indicate directions for future parent support.

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