31 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. References Abdou, C. M., Schetter, C. D., Jones, F., Roubinov, D., Tsai, S., Jones, L., Lu, M., & Hobel, C. (2010). Community perspectives: mixed-methods inves- tigation of culture, stress, resilience, and health. Ethnicity & disease, 20(1 Suppl 2), S2–48. Aune, I. & Möller A. (2010). “I want a choice, but I don’t want to decide” - A qualitative study of pregnant women’s experiences regarding early ul- trasound risk assessment for chromosomal anom- alies. Midwifery, 28(1), 14– 23. doi:10.1016/j. midw.2010.10.015 Baron, E., Field, S., Kafaar, Z., & Honikman, S. (2015). 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