November Research Update

Here is an update of all the relevant research that has been published in November.

Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature.

Wosu, A. C., Gelaye, B., & Williams, M. A.


The aims of this review are (i) to summarize and evaluate current knowledge on the association between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD) in pregnant and postpartum women, (ii) to provide suggestions for future research on this topic, and (iii) to highlight some clinical implications. Relevant publications were identified through literature searches of four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PsycARTICLES) using keywords such as “child abuse,” “posttraumatic stress,” “pregnancy,” and “postpartum”. Five studies were included in this review. Findings across all studies were consistent with higher prevalence of PTSD diagnosis or symptomatology among women with history of CSA. However, only findings from two studies were statistically significant. One study observed higher overall PTSD scores in women with CSA history compared to women with non-CSA trauma history or no trauma history during pregnancy (mean ± SD 1.47 (0.51) vs. 1.33 (0.41) vs. 1.22 (0.29), p < 0.001), at 2 months postpartum (mean ± SD 1.43 (0.49) vs. 1.26 (0.38) vs. 1.19 (0.35), p < 0.001), and at 6 months postpartum (mean ± SD 1.36 (1.43) vs. 1.20 (0.33) vs. 1.14 (0.27), p < 0.001). Another study observed that the prevalence of PTSD during pregnancy was 4.1 % in women with no history of physical or sexual abuse, 11.4 % in women with adult physical or sexual abuse history, 16.0 % in women with childhood physical or sexual abuse history, and 39.0 % in women exposed to both childhood and adult physical or sexual abuse (p < 0.001); in a subsequent analysis, the investigators reported that pregnant women with PTSD had over 5-fold odds of having a history of childhood completed rape compared to counterparts without PTSD (OR = 5.3, 95 % CI 3.2, 8.7). Overall, available evidence suggests positive associations of CSA with clinical PTSD or PTSD symptomatology among pregnant and postpartum women.

 [Premature delivery: A traumatic birth? Posttraumatic stress symptoms and associated features].

[Article in French]

Goutaudier, N., Séjourné, N., Bui, E., Cazenave, N., & Chabrol, H.


OBJECTIVES: While researches focusing on posttraumatic stress disorder (PTSD) symptoms following childbirth tend to develop, few studies have been conducted on French samples. The aim of the current study was to explore the prevalence rate of women developing postpartum PTSD following preterm birth and highlighting associated features.

PATIENTS AND METHOD: In the 4weeks following the preterm infant’s hospital discharge, a sample of 110 French women (mean age [SD]=29.5 [4.3]years) who delivered prematurely completed questionnaires assessing PTSD symptoms (Impact of Event Scale-Revised) postpartum depressive symptomatology (Edinburgh Postnatal Depression Scale), quality of marital relationship (Dyadic Adjustment Scale) and partner support (Multidimensional Scale of Perceived Social Support). Sociodemographic and gynecologic data were also gathered.

RESULTS: Thirty percent of our sample reported a score on the IES-R highlighting a probable posttraumatic stress disorder. Increased postpartum depressive symptoms (β=0.47, P<0.05), having undergone a caesarian section (β=0.24, P<0.05), and prior traumatic event (β=0.20, P<0.05), were independently associated with the intensity of PTSD symptoms.

DISCUSSION AND CONCLUSION: Given the traumatic impact of preterm birth on mothers, further studies focusing on the trauma of premature delivery are warranted.

Increased rate of parental postpartum depression and traumatization in moderate and late preterm infants is independent of the infant’s motor repertoire

Mehler, K., Mainusch, A., Hucklenbruch-Rother, E., Hahn, M., Hunseler, C., & Kribs, A.


Background: Moderately and late preterm infants represent a considerable and increasing proportion of infants cared for in neonatal departments worldwide. Parents of preterm infants are at risk of postpartal depression (PPD) and posttraumatic stress disorder (PTSD), and preterm infants are at risk of developmental impairment.

Aim: This study aimed to assess (1) the incidence of parental PPD and PTSD in moderate to late preterm infants in comparison to full-term infants and (2) the influence of infants’ motor repertoire assessed by Prechtl’s general movements and illness severity on parental PPD and PTSD.

Subjects: We studied 60 mothers and 56 fathers of 69 preterm infants (born at 32 to 37 weeks of gestation) and 32 mothers and 29 fathers of 34 full-term infants.

Outcome measures: We assessed the incidence of parental PPD, PTSD and perceived social support as well as infants’ illness severity and motor repertoire at birth, term and 3 months corrected age.

Results: Preterm mothers and fathers had significant higher depression scores after birth compared to full-term parents (p = 0.033 and 0.021). Preterm fathers also had higher traumatization scores compared to full-term fathers (p = 0.007). Probable or possible PPD/PTSD was not associated with infant’s illness severity or quality of motor repertoire. No differences in motor development were found between preterm and full-term infants.

Conclusion: Moderate to late preterm infants’ parents are at increased risk for PPD irrespective of infants’ motor repertoire or illness severity.

Posttraumatic stress disorder and risk of spontaneous preterm birth.

Shaw,  J. G, Asch, S. M., Kimerling, R., Frayne, S. M., Shaw, K. A., & Phibbs, C. S.


OBJECTIVE: To evaluate the association between antenatal posttraumatic stress disorder (PTSD) and spontaneous preterm delivery.

METHODS: We identified antenatal PTSD status and spontaneous preterm delivery in a retrospective cohort of 16,334 deliveries covered by the Veterans Health Administration from 2000 to 2012. We divided mothers with PTSD into those with diagnoses present the year before delivery (active PTSD) and those only with earlier diagnoses (historical PTSD). We identified spontaneous preterm birth and potential confounders including age, race, military deployment, twins, hypertension, substance use, depression, and results of military sexual trauma screening and then performed multivariate regression to estimate adjusted odds ratio (OR) of spontaneous preterm delivery as a function of PTSD status.

RESULTS: Of 16,334 births, 3,049 (19%) were to mothers with PTSD diagnoses, of whom 1,921 (12%) had active PTSD. Spontaneous preterm delivery was higher in those with active PTSD (9.2%, n=176) than those with historical (8.0%, n=90) or no PTSD (7.4%, n=982) before adjustment (P=.02). The association between PTSD and preterm birth persisted, when adjusting for covariates, only in those with active PTSD (adjusted OR 1.35, 95% confidence interval [CI] 1.14-1.61). Analyses adjusting for comorbid psychiatric and medical diagnoses revealed the association with active PTSD to be robust.

CONCLUSION: In this cohort, containing an unprecedented number of PTSD-affected pregnancies, mothers with active PTSD were significantly more likely to suffer spontaneous preterm birth with an attributable two excess preterm births per 100 deliveries (95% CI 1-4). Posttraumatic stress disorder’s health effects may extend, through birth outcomes, into the next generation.


A Randomized Controlled Trial of a Psycho-Education Intervention by Midwives in Reducing Childbirth Fear in Pregnant Women

Toohil, J., Fenwick, J., Gamble, J., Creedy, D. K., Buist, A., Turkstra, E., & Ryding, E-L.


Background: Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women’s childbirth fear.

Methods: Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy.

Results: There were significant differences between groups on postintervention scores for fear of birth (p < 0.001) and childbirth self-efficacy (p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant.

Conclusion: Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences.

It would be great to hear any suggestions of posts that you would be interested in reading in the new year. Please comment below with any ideas. Thank you 🙂