August 2018 – September 2018 Research Update

The association between the degree of nausea in pregnancy and subsequent posttraumatic stress.

Arch Womens Ment Health. 2018 Sep 17. doi: 10.1007/s00737-018-0909-z. [Epub ahead of print]

Kjeldgaard HKVikanes ÅBenth JŠJunge CGarthus-Niegel SEberhard-Gran M.


Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.


Maternal experiences of trauma and hair cortisol in early childhood in a prospective cohort.

Psychoneuroendocrinology. 2018 Aug 22;98:168-176. doi: 10.1016/j.psyneuen.2018.08.027. [Epub ahead of print]

Slopen NRoberts ALLeWinn KZBush NRRovnaghi CRTylavsky FAnand KJS.


BACKGROUND AND OBJECTIVE: Maternal trauma can have intergenerational consequences but little is known about whether maternal traumas affect key biological domains associated with mental health in their offspring. The objective of this study was to examine maternal lifetime history of traumatic events through mid-gestation in relation to offspring cortisol production in early childhood.

METHODS: The sample was comprised of 660 children (49.9% Black, 44.4% White) from a longitudinal study of mother-offspring dyads in Shelby County, Tennessee, followed from mid-gestation to child age 4 years (enrolled 2006-2011). Maternal lifetime history of traumatic life events were assessed mid-gestation using the Traumatic Life Events Questionnaire. Total cortisol output among offspring was measured using hair cortisol concentrations at ages 1 to 4 years.

RESULTS: Associations of maternal trauma history with child hair cortisol varied by child’s age. No association was observed at age 1 or 2. In adjusted regression models, at ages 3 and 4, offspring of mothers in the third (β = 0.99, P < .01), fourth (β=0.72, P < .05), and fifth (β=0.83, P < .01) quintiles of trauma exposure history had elevated (natural log) hair cortisol concentrations, relative to mothers in the lowest quintile (P-trend = 0.003). The associations were not attenuated after adjustment for theorized pathways, including premature birth, maternal postpartum depression, and maternal parenting stress.

CONCLUSIONS: Maternal lifetime trauma exposures are associated with offspring hair cortisol concentrations. Future research is needed to determine intermediary mechanisms and functional significance of elevated hair cortisol concentration in young children.


“The loss was traumatic… some healthcare providers added to that”: Women’s experiences of miscarriage.

Women Birth. 2018 Aug 25. pii: S1871-5192(17)30479-1. doi: 10.1016/j.wombi.2018.06.006. [Epub ahead of print]

Bellhouse CTemple-Smith MWatson SBilardi J.


BACKGROUND: Miscarriage is a common event in Australia and is estimated to occur in up to one in four confirmed pregnancies. Prior research has demonstrated that miscarriage is associated with significant distress, grief and loss, and in some cases clinically significant levels of depression, anxiety, and Post Traumatic Stress Disorder. Despite these consequences for women’s emotional and mental health, studies have commonly found that women feel that healthcare providers often lack empathy, support, and acknowledgement of their loss.

AIM: The aim of this study is to explore the psychological distress experienced by women as a result of miscarriage, as well as the perceived support provided by healthcare professionals.

METHODS: Fifteen women were recruited in Australia and participated in semi-structured interviews either in person or over the telephone.

FINDINGS: It was found that for most women, the levels of distress, grief, and loss associated with their miscarriages were significant. While women experienced both positive and negative interactions with healthcare providers throughout their miscarriage journeys, all women interviewed expressed their increased distress following negative experiences.

CONCLUSION: A number of recommendations have been provided by women to improve the service of healthcare providers in the event of a miscarriage, including referral to a psychologist, and ongoing follow-up after their miscarriage, which women felt would assist them with managing their distress.


Childbirth as a forthcoming traumatic event: pretraumatic stress disorder during pregnancy and its psychological correlates.

J Reprod Infant Psychol. 2018 Aug 10:1-12. doi: 10.1080/02646838.2018.1504284. [Epub ahead of print]

Goutaudier NBertoli CSéjourné NChabrol H.


BACKGROUND: Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, ‘but largely ignored’, aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms.

METHODS: At 34 weeks’ gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms.

RESULTS: 8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity.

CONCLUSION: Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis.


[Study of the relations between the pain of childbirth and postpartum, and depressive and traumatic symptoms].

[Article in French]

Gynecol Obstet Fertil Senol. 2018 Sep;46(9):658-663. doi: 10.1016/j.gofs.2018.06.002. Epub 2018 Jun 19.

Séjourné NDe la Hammaide MMoncassin AO’Reilly AChabrol H.


OBJECTIVES: This study aims to determine the incidence of pain in childbirth and postpartum on depressive and post-traumatic symptomatology 6weeks after delivery.

METHODS: One hundred and nine women who gave birth in maternity hospitals of type 2$participated in the study. Two to four days after delivery they have completed five self-administered questionnaires to assess pain of childbirth (QDSA), dramatization of pain (PCS-CF), satisfaction of childbirth (CEQ), peri-traumatic distress (IDP) and depressive symptoms (EPDS) and visual analogue scales to measure immediate postnatal pain. Six weeks after birth they have again completed questionnaires to measure pain (QDSA and visual analogue scales) and depressive symptoms (EPDS) and a scale measuring posttraumatic symptomatology (IES-R).

RESULTS: The pain of childbirth and immediate postpartum was associated with depressive (r=0.27 and r=0.31 respectively) and traumatic symptomatology (r=0.30 and r=0.34 respectively) in postpartum. Regression analysis, however, revealed that only the depressive symptomatology and the affective dimension of postpartum pain at six weeks post-partum was related to post-traumatic stress.

CONCLUSION: The results of this study highlight the importance to support the pain of childbirth but also the pain occurring in the postpartum period.


Depression, posttraumatic stress and relationship distress in parents of very preterm infants.

Arch Womens Ment Health. 2018 Aug;21(4):445-451. doi: 10.1007/s00737-018-0821-6. Epub 2018 Mar 3.

Winter LColditz PBSanders MRBoyd RNPritchard MGray PHWhittingham KForrest KLeeks RWebb LMarquart LTaylor KMacey J.


To determine the prevalence, associated factors, and relationships between symptoms of depression, symptoms of posttraumatic stress (PTS), and relationship distress in mothers and fathers of very preterm (VPT) infants (< 32 weeks). Mothers (n = 323) and fathers (n = 237) completed self-report measures on demographic and outcome variables at 38 days (SD = 23.1, range 9-116) postpartum while their infants were still hospitalised. Of mothers, 46.7% had a moderate to high likelihood of depression, 38.1% had moderate to severe symptoms of PTS, and 25.1% were in higher than average relationship distress. The corresponding percentages in fathers were 16.9, 23.7, and 27%. Depression was positively associated with having previous children (p = 0.01), speaking little or no English at home (p = 0.01), financial stress (p = 0.03), and recently accessing mental health services (p = 0.003) for mothers, and financial stress (p = 0.005) and not being the primary income earner (p = 0.04) for fathers. Similar associations were found for symptoms of PTS and relationship distress. Being in higher relationship distress increased the risk of depression in both mothers (p < .001) and fathers (p = 0.03), and PTS symptoms in mothers (p = 0.001). For both mothers and fathers, depression was associated with more severe PTS symptoms (p < .001). Fathers of VPT infants should be screened for mental health problems alongside mothers, and postpartum parent support programs for VPT infants should include strategies to improve the couple relationship.


Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression.

Arch Womens Ment Health. 2018 Aug;21(4):391-399. doi: 10.1007/s00737-017-0807-9. Epub 2017 Dec 29.

Hanschmidt FTreml JKlingner JStepan HKersting A.

Erratum in

Correction to: Stigma in the context of pregnancy termination after diagnosis of fetal anomaly: associations with grief, trauma, and depression. [Arch Womens Ment Health. 2018]


Termination of pregnancy after diagnosis of fetal anomaly (TOPFA) is a contested issue and stigma may negatively impact affected women’s psychological reactions. This study examined the influence of perceived and internalized stigma on women’s long-term adjustment to a TOPFA. One hundred forty-eight women whose TOPFA dated back 1 to 7 years responded to self-report questionnaires. The associations between perceived stigma at the time of the TOPFA, current internalized stigma and symptoms of grief, trauma and depression were modeled using multiple linear regression. The proportion of participants reporting scores above the cutoffs on the respective scale was 17.6% for grief, 18.9% for posttraumatic stress, and 10.8% for depression. After controlling for time since the TOPFA, pre-TOPFA mental health and obstetric variables, higher levels of current internalized stigma were related to higher levels of grief, trauma, and depression. Mediation analyses suggested that the effect of perceived stigma at the time of the TOPFA on symptoms of grief and trauma was mediated by current internalized stigma, but the cross-sectional design limited causal interpretation of results. Internalized stigma is associated with long-term psychological distress following a TOPFA. Perceived stigma at the time of the TOPFA may contribute to increased trauma and grief symptomatology, but results need to be validated in longitudinal studies. Health care providers and public initiatives should aim at reducing stigma among affected women.

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