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Family experiences of antenatal counselling of spina bifida: a systematic review
  1. Shreya Agrawal1,
  2. Esther V Hobson2,
  3. Anthony Richard Hart3
  1. 1 The University of Sheffield Medical School, Sheffield, UK
  2. 2 Department of Neurology, The University of Sheffield Institute for Translational Neuroscience, Sheffield, UK
  3. 3 Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Anthony Richard Hart, Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK; anthony.hart{at}


Objective To describe families’ experiences of antenatal counselling of spina bifida.

Design Systematic review.

Methods MEDLINE, CINAHL, PsycINFO and Embase databases were searched using a combination of Medical Subject Headings and text/abstract terms. Case reports, survey results and qualitative interview data were included. The quality of research was evaluated using the Critical Appraisal Skills Programme checklist.

Results 8 papers were included. Families described shock and grief at diagnosis, with some immediately offered termination of pregnancy (TOP) even though they knew little about the condition. Positive and negative aspects of care were found. Teams that were gentle, kind and empathetic, who did not use jargon, and highlighted positive and negative aspects of the baby’s life were seen favourably. Callous language, and overly negative or incorrect counselling was not, particularly if there was pressure to agree to TOP. Families based their decisions on how they would cope, the effect on siblings and the baby’s likely quality of life. Prenatal surgery was viewed positively. The views of families who chose TOP, were happy with their care, partners, families, and the LGBTQ+ community were under-represented in the literature.

Conclusions Unlike other conditions where limited data on outcome exist or the spectrum is genuinely broad, the outcomes of children with spina bifida is well described. Poor aspects of antenatal counselling were described frequently by families, and further work is needed to capture the full spectrum of views on antenatal counselling, how it can be improved, and what training and resources healthcare professionals need to perform it better.

  • child development
  • neonatology
  • neurology
  • neurosurgery

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors SA performed the systematic review, assessed risk of bias, analysed results and wrote the first draft of the paper. EVH provided advice on methodology, assessed risk of bias and contributed to the final version of the paper. ARH was involved in assessing inclusion and exclusion of studies, analysed the results and wrote the second draft of papers.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.