Technological improvements have enhanced the precision and depth of prenatal screenings. However, these screenings present several limitations. False-positive (FP) results, where screening tests indicate a risk of anomalies that are later ruled out by confirmatory diagnostic testing, remain a significant challenge [4]. These may result from variability in maternal biomarkers, gestational age miscalculations, or limitations in screening tools’ sensitivity and specificity. Although diagnostic procedures like amniocentesis or chorionic villus sampling (CVS) can provide a definitive diagnosis, they are invasive and carry risks, including miscarriage, which can further increase the anxiety of expectant parents [5, 6].

Series of increasingly invasive diagnostics procedures often follow FP results, significantly impacting the emotional well-being of parents. It goes all the way from joyful expectations to deep concerns. Some short-term and long-term psychological implications, such as anxiety, depression, and stress in mothers, can affect their relationship with the fetus and impact family dynamics, as highlighted by several research studies [4, 5, 6].

Prenatal diagnostic processes vary across health sectors, leading to differences in outcomes after such investigations. Ultrasonographic assessment, considered essential for detecting structural anomalies, is typically performed at a gestational age of 18–22 weeks. However, studies indicate that approximately 50% of morphological abnormalities can be visualized in the first-trimester, with lower FP rates [2, 3]. This means that in severe cases, early diagnosis can help determine whether the pregnancy should be continued or appropriately terminated [4, 5, 6].

Despite technological advancements, there remains a significant gap in understanding the psychological and emotional impact of FP results from prenatal screening. Early screening increases detection rates and provides ample time for decision-making. However, existing research has focused mainly on operational performance metrics, such as detection rates and predictive values [7, 8, 9, 10, 11, 12]. Few studies analyze how screening impacts maternal mental health, family relationships, or healthcare decision-making. The long-term emotional impacts on parents and families are not adequately addressed. Therefore, this systematic review aims to address the gaps in the existing literature by synthesizing studies on the psychological impacts of FP prenatal screening results. Emotional outcomes, including anxiety, depression, and stress, will be discussed, and their impact on parental-fetal attachment and family decision-making will be considered.

In this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines [13] were followed to ensure a structured and transparent approach to the review process. The Population, Exposure, Comparison, and Outcome (PECO) protocol utilized for this review is as follows:

$\bullet$ Population (P): The review focused on pregnant women who underwent obstetric screening tests and received FP results.

$\bullet$ Exposure (E): The exposure of interest was receiving a FP result from an obstetric screening test, which includes, but is not limited to, screenings for Down syndrome, neural tube defects, and other genetic or structural anomalies.

$\bullet$ Comparator (C): The comparator group comprised pregnant women who underwent obstetric screening tests and received negative or true-positive results, although having a comparator was not mandatory.

$\bullet$ Outcome (O): The primary outcomes assessed included psychological factors such as anxiety, depression, stress levels, and emotional well-being (measured by validated scales such as State-Trait Anxiety Inventory (STAI), Positive and Negative Affect Schedule (PANAS), and Hospital Anxiety and Depression Scale). Additionally, parental attitudes and maternal representations (e.g., altered perceptions of pregnancy and baby) were considered.

Table 1 presents the selection criteria devised for this review.

A comprehensive database search protocol was developed to identify relevant studies pertaining to the objectives of this review across seven electronic databases. These databases included PubMed, EMBASE, PsycINFO, Cochrane Library, Web of Science, Scopus, and CINAHL. The search strategy was designed using a combination of Medical Subject Headings (MeSH) terms, keywords, and Boolean operators to ensure a thorough and precise retrieval of relevant literature. The search strategy was developed to include terms related to obstetric screening, FP results, and psychological outcomes. Boolean operators “AND” and “OR” were used to combine search terms. The “AND” operator narrowed the search by including studies that contained all the search terms. In contrast, the “OR” operator broadened the search by including studies that contained any of the search terms. The search terms were adjusted for each database to fit with the respective indexing system and search functionalities. The search strings utilized across the different databases are elucidated through Table 2.

The data extraction protocol for this review was initiated using a standardized data extraction form, which was developed and pre-tested on a subset of included studies to ensure consistency and completeness. This form was then used to extract data from all the eligible studies. Two independent reviewers performed the data extraction, and any discrepancies between the reviewers were resolved through discussion or consultation with a third reviewer, ensuring a high level of accuracy and reliability in the data extracted.

Data items selected for extraction were as follows:

(1) General Information: This included the name of the author(s), year of publication, and country where the study was conducted.

(2) Study Characteristics: Design of the study, setting, sample size, duration of follow-up, and method of recruitment were recorded.

(3) Participant Demographics: Age, gestational age at screening, and other relevant demographic information, including socioeconomic status or parity, were noted.

(4) Details of Obstetric Screening: The screening test type, the specific FP condition screened, and the timing of the screening relative to gestational age were documented.

(5) Outcome Measures: The primary psychological outcomes measured (e.g., anxiety, depression, stress levels), the instruments or scales used for measurement, and the time points of outcome assessement were extracted.

(6) Results: Key findings, including statistical significance, effect sizes, and confidence intervals, were compiled.

(7) Quality Assessment: Information relevant to the methodological quality of each study and the risk of bias was gathered, based on the predetermined quality assessment tools.

(8) Conclusions: The authors’ interpretations of the results, their implications for clinical practice, and recommendations for future research were summarized.

The risk of bias in the included non-randomized studies of interventions (NRSI) for this review was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool [14], whereas the Appraisal Tool for Cross-Sectional Studies (AXIS) tool was employed for the selected cross-sectional studies [15].

In conjunction with the bias assessment using the ROBINS-I and AXIS tools, the systematic review also incorporated the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach [16] to assess the overall certainty of the evidence regarding the psychological impact of FP results in obstetric screening. Following the individual risk of bias appraisals for each study, the GRADE framework was applied to evaluate the body of evidence across the outcomes reported in these studies.

Starting with the first 522 entries obtained from the assessed databases, Fig. 1 illustrates the study selection process. 454 records remained, of which 68 duplicate records were removed before the screening process. Due to access issues, 52 data were excluding, leaving 402 records for further examination. Additionally, 46 records were unavailable for the comprehensive review. The remaining 356 records underwent a comprehensive eligibility assessment. At this stage, 47 entries were removed as they were not related to the research topic, and 79 records failed to meet the established PECO criteria. In this review phase, 51 narrative reviews, 51 animal studies, and 62 scoping reviews were also excluded due to their disagreement with the inclusion criteria. Using these criteria, it was determined that 7 studies [17, 18, 19, 20, 21, 22, 23] should be included in the systematic review.

The ROBINS-I tool (Fig. 2) revealed that Bardi et al. [17] and Viaux-Savelon et al. [21] each had an overall moderate risk of bias. This moderate rating was primarily driven by concerns in domain 3 (D3), which relates to deviations from intended interventions, and in domain 5 (D5), related to the measurement of outcomes in the study by Viaux-Savelon et al. [21]. The remaining domains for these studies were assessed as low risk, indicating a generally robust methodological approach. Burton et al. [18] demonstrated a low overall risk of bias, although moderate concerns were noted in domains 6 (D6) and 7 (D7), which address the selection of the reported result and bias in participant selection, respectively. Marteau et al. [19], however, maintained a low risk across all domains, except for domain 1 (D1), associated with confounding factors, where it was rated as moderate.

Using the AXIS tool (Fig. 3), Tu et al. [20] and Wood et al. [23] were found to have a low overall risk of bias, exhibiting robust methods across most domains. Tu et al. [20], however, exhibited a moderate concern in the domain of reporting bias. Wood et al. [23] showed a moderate risk in the selection domain, which involves the representativeness and recruitment of the study sample. Wiggins et al. [22] presented a moderate overall risk of bias, with moderate concerns in several domains. Specifically, there were moderate concerns in the performance domain (evaluating the blinding of participants and personnel to the study hypothesis),the detection domain (assesses the blinding of outcome assessment), and the ‘other’ domain (covering biases not addressed in other domains).

Table 3 shows the included studies [17, 18, 19, 20, 21, 22, 23] that assessed the psychological impact of FP results in obstetric screening. Bardi et al. [17] conducted a prospective cohort study involving 1512 women who consented to participate, with retention rates decreasing across four time points. The methodology included a 13-week anomaly scan followed by four online questionnaires (Q1–Q4) designed to measure anxiety and affect using the STAI, PANAS, as well as ad hoc questionnaires. The longitudinal design and use of validated psychological measures allowed for an assessment of the trajectory of psychological distress over time.

Burton et al. [18] studied 205 women and their partners in an experimental group, and 192 control subjects with 148 male partners. They employed sequential assessments with tools such as the A-State scale and Maternal Attitude to Pregnancy Instrument. The study controlled for race, social class, and pregnancy planning status, providing valuable insights into the psychological impact of FP screening results while accounting for potential confounding factors. Marteau et al. [19] compared the psychological effects over time among 372 women, including 346 with negative and 26 with initially positive maternal serum alpha-fetoprotein (MS-AFP) screening results. The comparison was conducted over four time points, allowing for an analysis of the psychological impact from the receipt of the initial screening result to the resolution of the FP result.

Tu et al. [20] focused on a smaller sample size, examining 49 infants with FP results and 42 with normal results. The study involved structured interviews, incorporating a Likert scale and the Parenting Stress Index, to measure the psychological burden on parents who received FP results for their infants. Viaux-Savelon et al. [21] conducted a prospective case-control study with 19 pregnant women who had received positive SM screening results but later received reassuring follow-up, and 19 matched controls. They assessed anxiety, depression, and maternal representations, as well as included videotaped mother-infant interactions to observe the potential impact on the mother-infant relationship.

Wiggins et al. [22] included 375 women with a FP ovarian cancer screening result. The study performed assessments at baseline and at 4 months post-FP result within an ovarian cancer screening program, allowing for an examination of the short-term psychological effects of FP results. Wood et al. [23] studied 26 women from hereditary nonpolyposis colorectal cancer (HNPCC) families attending gynaecological screening, using the Hospital Anxiety and Depression Scale and the Short Form-36v2. Assessments were made during the gynaecological screening and followed up at 3 and 6 months, providing a focused examination of the psychological impact in a high-risk population.

Bardi et al. [17] implemented a prospective cohort study that administered four online questionnaires at specific intervals after a 13-week anomaly scan. Their findings revealed a pattern where anxiety levels decreased and well-being increased following a normal scan result. In cases of FP results, anxiety levels exhibited an initial increase but then decreased around the 20-week scan, indicating a temporal psychological disturbance associated with FP findings. Burton et al. [18] conducted sequential assessments using the A-State scale and the Maternal Attitude to Pregnancy Instrument, while also controlling for demographic variables. Their results indicated a significant rise in anxiety after the notification of elevated maternal serum alpha-fetoprotein, which sharply decreased after the receipt of normal follow-up results. However, in cases of successive elevated results, anxiety levels remained high, underscoring the sustained psychological impact of recurring uncertain screening outcomes.

Marteau et al. [19] compared the psychological impact across four-time points consequent to MS-AFP screening results. The study reported high anxiety and negative attitudes toward pregnancy and the baby following abnormal results with a subsequent reduction in anxiety after confirmatory procedures, such as amniocentesis that yielded normal results. This suggests that follow-up procedures can significantly alleviate initial psychological distress caused by abnormal screening results. Tu et al. [20] employed structured interviews using Likert scales and the Parenting Stress Index to evaluate the psychological impact on parents of infants with FP results. The study found that parents in the FP group experienced higher stress levels, more frequent hospitalizations, and increased physician visits, indicating a substantial psychological and practical burden associated with FP outcomes in infant screening.

Viaux-Savelon et al. [21] utilized a prospective case-control design and conducted assessments for anxiety, depression, and maternal representations, including analysis of videotaped mother-infant interactions. Their findings revealed that women with positive SM screening results who later received reassuring follow-up exhibited higher levels of anxiety and depression, alterations in maternal representations, and perturbations in mother-infant interactions. These results imply that FP screening results can have far reaching effects on both mental health and parent-child dynamics.

Wiggins et al. [22] focused on the psychological outcomes at baseline and 4 months post-FP result in an ovarian cancer (OC) screening program. They identified greater social constraint and less education as factors linked to greater distress, and highlighted various predictors for both short-term and long-term psychological outcomes. Such findings underscore the complex interplay of social and educational factors in the psychological response to FP screening results. Wood et al. [23] applied the Hospital Anxiety and Depression Scale (HADS) and Short Form36v2 in a cohort of women from HNPCC families attending gynaecological screening, with follow-ups at 3 and 6 months. They reported no significant impact on anxiety or depression from FP results and found that health perceptions remained unchanged. This suggests a resilience or perhaps an informed preparedness in this high-risk population that might mitigate the psychological impact of FP screening outcomes.

Bardi et al. [17] observed that there was a high initial level of anxiety among parents who received FP results, which decreased over time. They quantified this anxiety, noting that 27.9% of participants experienced clinically relevant anxiety at the first questionnaire (Q1), with a decremented prevalence at subsequent assessments. Although the study did not explicitly measure the impact on mother-infant interaction, the trajectory of parental anxiety suggests potential implications for early parental engagement. Burton et al. [18] found heightened anxiety in both mothers and fathers during the testing period, which alleviated after the receipt of normal results. This study did not specifically address mother-infant interaction; however, the elevated anxiety in both parents during the screening process could suggest a period of increased stress that might influence family dynamics. Marteau et al. [19] reported increased parental anxiety and worry after receiving abnormal screening results, which decreased following amniocentesis that confirmed normal development. While this study did not measure mother-infant interaction directly, the reported negative attitudes towards pregnancy and the baby, post-abnormal results could potentially affect maternal behaviours and the mother-infant bond.

Tu et al. [20] documented that mother of infants with FP results reported higher stress and concerns regarding their child’s future health. In contrast, fathers’ stress levels were similar between the FP and normal result groups. The study did not specifically measure the impact on mother-infant interaction, but the increased maternal stress levels could have implications for the quality of caregiving and attachment. Viaux-Savelon et al. [21] identified increased maternal anxiety, depression, and altered maternal representations in the context of FP screening results. Furthermore, this study provided evidence of dysregulated mother-infant interactions, characterized by lower maternal sensitivity, higher maternal intrusiveness, and higher infant avoidance. These findings are indicative of a significant impact on the mother-infant relationship, likely mediated by the mother’s psychological state.

Wiggins et al. [22] found that greater distress in parents was linked to demographic and psychological factors, with lower education levels and greater social constraint being associated with increased distress. The study did not examine the impact on mother-infant interaction, but the findings suggest that socio-demographic factors play a crucial role in the parental psychological response to FP results. Wood et al. [23] reported no increase in anxiety or depression among parents following FP results. The absence of significant psychological impact in this study suggests that, under certain circumstances or within specific populations, parents may exhibit resilience or employ effective coping strategies that help buffer the stress associated with FP findings. This study did not address mother-infant interaction, but the lack of heightened anxiety or depression suggests a relatively stable parent-infant dynamic post-screening.

This study underlines the need to identify and address the psychological effects of FP results in prenatal screening within the clinical decision-making and counseling process. Elevated parental anxiety, as reported in studies such as Bardi et al. [17], Burton et al. [18], and Marteau et al. [19], demonstrate the need for healthcare professionals to antecipate and manage emotional reactions, especially during the testing phase and following the notification of abnormal results. High levels of maternal stress and altered maternal representations, as highlighted by Viaux-Savelon et al. [21] and Tu et al. [20], suggest that FP findings may indirectly affect early caregiving, potentially influencing later child development. These aspects highlight of timely follow-up processes, such as confirmatory tests like amniocentesis, to reduce stress levels in parents and clarify the situation.

$\bullet$ Enhanced Counseling: Thorough pre- and post-screening counseling to educate parents on the possibility of FPs, limitations of screening tests, and availability of confirmatory diagnostics.

$\bullet$ Rapid Follow-Up Diagnostics: Efficient access to confirmatory procedures, such as amniocentesis or detailed ultrasounds, to minimize the time parents spend in a state of uncertainty and anxiety.

$\bullet$ Psychological Support: Inclusion of mental health services, for example referring to psychologists or support groups, to help parents better cope with stress and anxiety over the outcome of the screening.

$\bullet$ Tailored Communication: Develop communication protocols based on clarity, empathy, and reassurance to reduce stress and distress, especially for vulnerable socio-demographic groups that had been identified by Wiggins et al. [22].

$\bullet$ Parental Education Programs: It provides educational resources that promote better understanding of the prenatal screening process and outcomes that reduce misinformation and increase resilience among parents, as suggested by the relatively stable results reported by Wood et al. [23].

$\bullet$ Early Interventions for Risk Groups: Additional support offered to populations at higher risk for psychological distress, such as those with lower education levels or greater social constraint, as emphasized by Wiggins et al. [22].

As evident through the findings shown in Table 4, for the case-control studies (Bardi et al. [17], Burton et al. [18], Marteau et al. [19], and Viaux-Savelon et al. [21]), the observed common finding was that early anomaly scans can impact maternal anxiety and well-being, with FPs causing a temporary increase in anxiety. This anxiety was found to normalize following confirmation of optimal outcomes. The risk of bias for these studies was low to moderate, with moderate concerns identified in specific domains as assessed by the ROBINS-I tool. Inconsistency among these studies was low, as they generally agreed on the temporary nature of the anxiety. Indirectness and imprecision were also low, indicating that the studies directly assessed the outcome of interest and provided sufficient data to support their findings. No other concerns were identified, leading to a moderate certainty in the evidence.

For the cross-sectional studies (Tu et al. [20], Wiggins et al. [22], and Wood et al. [23]), it was observed that FP results significantly increase parental stress and concerns, particularly among mothers, with demographic and other factors influencing psychological outcomes. The risk of bias was low, as reported by the AXIS tool, suggesting that the studies employed methodologically appropriate approaches in the context of cross-sectional research. Inconsistency and indirectness were low, indicating that findings were consistent across studies and applicable to the research question. Imprecision was also low, meaning that the study results were precise enough to draw conclusions. Given these considerations, the certainty of the evidence from the cross-sectional studies was also rated as moderate.

The included studies [17, 18, 19, 20, 21, 22, 23] collectively demonstrate that FP results in prenatal and newborn screening can significantly affect parental psychological well-being, although the severity and persistence of these effects vary. Bardi et al. [17] and Burton et al. [18] observed transient increases in parental anxiety following FP results, with anxiety levels returning to baseline after confirmatory testing. While Bardi et al. [17] focused exclusively on maternal anxiety during early anomaly scans, Burton et al. [18] included both maternal and paternal perspectives, underscoring the shared emotional burden between partners. Similarly, Marteau et al. [19] reported heightened anxiety following abnormal results, coupled with negative attitudes toward both the pregnancy and the baby. This finding provides a nuanced understanding of how FP results might shape perceptions of the pregnancy, even if follow-up testing ultimately alleviates anxiety.

Tu et al. [20] highlighted the disproportionate stress burden on mothers compared to fathers, emphasizing the need for targeted support for maternal emotional health. While these findings align with the short-term psychological responses described in earlier studies, Viaux-Savelon et al. [21] extended the narrative by demonstrating how FP results can disrupt mother-infant interactions, including increased maternal intrusiveness and higher infant avoidance. This broader impact highlights the potential for long-term consequences that go beyond transient parental anxiety.

Wiggins et al. [22] explored how demographic, dispositional, and social-environmental factors influence psychological responses to FP results, underscoring that distress levels are not uniform across populations. Parents with lower education levels or those experiencing greater social constraints were more likely to report higher distress levels. These findings emphasize the importance of tailoring interventions to demographic vulnerabilities, as psychological outcomes are influenced not only by screening results but also by external social and personal factors.

In contrast, Wood et al. [23] found no significant psychological impact in a specific population undergoing gynecological screening for cancer, suggesting that certain screening contexts or populations may be less susceptible to the emotional effects of FP results. This outlier underscores the variability in psychological responses based on the screening modality, population characteristics, and counseling practices.

FP results in prenatal and newborn screening have implications beyond immediate parental anxiety. Historical data, as referenced in newborn screening programs, indicate that parents often misinterpret FP findings, perceiving their children as medically fragile despite confirmatory tests ruling out anomalies [24, 25, 26, 27, 28, 29]. This persistent perception aligns with the concept of “vulnerable child syndrome”, characterized by unwarranted parental concerns over their child’s health and susceptibility to future illnesses [29, 30, 31]. Such perceptions can lead to overprotective parenting, altered caregiving dynamics, and challenges in the parent-child relationship, as highlighted by studies like Viaux-Savelon et al. [21].

These findings highlight the practical significance of addressing the psychological impact of FP results in prenatal and newborn screening. First, counseling and communication strategies must be improved to mitigate the emotional burden on parents. Clear and empathetic explanations of screening limitations and the potential for FP results can help manage expectations. Rapid access to confirmatory diagnostic tests can also help alleviate parental anxiety by reducing the duration of uncertainty. Additionally, providing tailored support for vulnerable groups, such as parents with lower educational levels or those experiencing social constraints, can help bridge the gaps identified in studies like Wiggins et al. [22].

Integrating psychological support services into prenatal and newborn care is critical, particularly for mothers, who consistently report higher stress levels than fathers [4]. This support can range from referrals to counselling services to the creation of peer-support networks for parents experiencing similar concerns. By addressing these impacts proactively, healthcare providers can foster more positive parental experiences and improve the long-term well-being of both parents and children.

The review of findings from Liehr [32] and Pylypjuk and Monarrez-Espino [33] provided additional perspectives on the psychological and clinical impacts of FP screening results, as well as the efficacy of such screenings. Liehr [32] focused on non-invasive prenatal testing (NIPT) and found a significant discrepancy between FP and false-negative rates, with a 27:1 ratio. They raised concerns about the efficiency of NIPT compared to first-trimester screening and highlighted the lack of reporting on children born with chromosomal aberrations that were not detected by NIPT. This contrasts with the findings from our review, which primarily discussed the psychological impact of FPs, whereas Liehr [32] emphasized the statistical and clinical aspects of NIPT’s efficacy and limitations.

Pylypjuk and Monarrez-Espino [33] conducted a meta-analysis to explore the utility of FP second-trimester maternal serum screening (MSS) for Down syndrome as a marker of placentally mediated complications. They found increased odds of preeclampsia and stillbirth in pregnancies with FP MSS, but no significant association with preterm birth or growth restriction. In contrast to our review’s focus on psychological distress, Pylypjuk and Monarrez-Espino’s work [33] has clinical implications, suggesting that a FP MSS may have predictive value for certain complications.

Green et al. [34] explores a broader scope of psychosocial impacts of screening programs on parents, including knowledge, anxiety, and long-term effects. Their findings aligned with our review, particularly in the immediate increase in anxiety following a positive screening result, as well as the potential for residual anxiety even after reassuring follow-up results. However, they also discussed the adequacy of knowledge transfer to parents, the effects of screening information on anxiety, and the uptake of neonatal screening, which were not covered in our review.

The review conducted by White and Algeri [35] provided a comprehensive statistical analysis of the lifetime risk of receiving at least one FP result from screening tests, based on adherence to standardized guidelines. Their study estimated that the probability is strikingly high, particularly among certain subpopulations recommended for more frequent screening. This finding underscores the significance of FPs as a common occurrence within the healthcare system, highlighting the need for patient education regarding this risk.

In contrast, Labonté et al. [36] focused on a narrower aspect of screening, specifically the psychological and social consequences of NIPT for chromosomal anomalies. Their scoping review, which included studies using validated psychological tests and qualitative assessments, provides valuable insights into the emotional and decision-making challenges faced by women undergoing NIPT.

Comparing the findings from our review with those of White and Algeri [35] and Labonté et al. [36], several similarities and differences emerge. A similarity is the acknowledgment of FPs as a source of psychological distress, as highlighted in the studies by Bardi et al. [17], Burton et al. [18] and Marteau et al. [19] in our review, as well as by the anxiety and distress reported by Labonté et al. [36]. Furthermore, the transient nature of this distress after follow-up procedures found in our review parallels the psychological outcomes examined by Labonté et al. [36], where the use of specific psychological tests likely measured short-term impacts.

A notable difference lies in the scope and methodology. While White and Algeri [35] provided a quantitative risk assessment of FPs over a lifetime, our review, along Labonté et al. [36], discussed the psychological impact of FP results from a qualitative perspective. Moreover, the studies in our review spanned a range of obstetric screenings and included both maternal and paternal experiences, whereas Labonté et al. [36] concentrated exclusively on the consequences of NIPT, reflecting a more focused examination of prenatal screening. The outlier study by Wood et al. [23] stands as an outlier in our review, contrasting with the general consensus of increased psychological distress reported in the other studies and those included in Labonté et al. [36]. This suggests that the impact of FPs may vary significantly based on screening type and population, a perspective not directly addressed in White and Algeri [35], which did not differentiate between the psychological and medical consequences of FPs.

The collective limitations of the studies included in this review must be understood within the context of several key methodological and interpretive constraints. The heterogeneity of study designs, which range from quantitative assessments to qualitative analyses, introduces a significant challenge in synthesizing and comparing outcomes. This variation affects the ability to draw consistent conclusions about the psychological impact of FP obstetric screening results. Moreover, the diversity in population demographics and geographical locations limits the generalizability of the findings to broader audiences. Additionally, the temporal scope of these studies is a limitation, as most of them assessed the psychological impact within a short-term framework, potentially overlooking long-term consequences. This short-term focus fails to provide insight into whether psychological distress persists over time or impacts future healthcare decisions or family dynamics. The studies’ reliance on self-reported measures of psychological outcomes is also a limitation due to the subjective nature of these reports, which may be influenced by recall bias or social desirability bias. Objective measures of psychological impact are rarely used, which could provide a more accurate assessment of the true psychological burden of FP results.

$\bullet$ Firstly, it is recommended that healthcare providers acknowledge the potential for immediate psychological distress following FP results and offer timely, clear and empathetic communication to help alleviate anxiety. This includes providing patients with information about the likelihood of FPs and what subsequent steps will be taken to clarify their results.

$\bullet$ Given the transient nature of anxiety, which tends to normalize after confirmatory testing, it is advisable to minimize the time between the initial screening and the follow-up procedures. Prompt provision of confirmatory tests can help reduce the duration of psychological distress.

$\bullet$ Given the findings that the impact of FP results may extend to negative attitudes and potentially affect parent-infant interactions, healthcare systems should consider implementing supportive counseling services. Such services could help parents cope with the stress associated with FP findings and prevent longer-term psychological sequelae.

$\bullet$ This review also indicates the importance of including both mothers and fathers in the support process, as both may experience stress in the face of uncertain screening results. Therefore, a recommendation would be to provide counseling and support resources to both parents, recognizing the shared nature of the screening process and its outcomes.

$\bullet$ Moreover, as some studies suggest that reactions to FP results are influenced by demographic, dispositional, and social-environmental factors, personalized care approaches should be adopted [34, 35, 36]. Healthcare providers might benefit from utilizing screening tools that identify individuals at higher risk of psychological distress, enabling targeted interventions to support those most in need.