Prenatal insomnia and childbirth-related PTSD symptoms: A prospective population-based cohort study

Malin Eberhard-Gran,Antje Horsch,Camille Deforges,Susan Garthus-Niegel,Yvonnick Noël

doi:10.1016/j.jad.2021.08.024

Abstract

BackgroundCertain populations are at high risk of experiencing a traumatic event and developing post-traumatic stress disorder (PTSD). Yet, primary preventive interventions against PTSD are lacking. It is therefore crucial to identify pre-traumatic risk factors, which could be targeted with such interventions. Insomnia may be a good candidate, but studies on civilians are sparse. Furthermore, the mechanisms at stake in the relationship between pre-traumatic insomnia and PTSD symptoms are unclear. MethodsThis prospective population-based cohort study (n = 1,610) examined the relationship between insomnia symptoms at 32 weeks of pregnancy and childbirth-related PTSD (CB-PTSD) symptoms at eight weeks postpartum. Postnatal insomnia symptoms, prenatal psychological symptoms (depression, anxiety, PTSD, fear of childbirth), subjective birth experience (SBE) and birth medical severity were included as covariates in the analyses, which were based on a Piecewise Structural Equation Modelling approach. ResultsThe relationship between prenatal insomnia and CB-PTSD symptoms was mediated by negative SBE and postnatal insomnia symptoms. All relationships involving insomnia symptoms had small or very small effect sizes. LimitationsThis study used self-report questionnaires. Postnatal insomnia and CB-PTSD symptoms were concurrently measured. ConclusionPrenatal insomnia symptoms may impair the ability to cope with a difficult birth experience and contribute to postnatal insomnia, a risk factor for CB-PTSD. Thus, prenatal insomnia symptoms may be a promising target for CB-PTSD primary preventive interventions, although other prenatal psychological symptoms could also be considered. Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate.

Highlights

Triggered by a traumatic experience, post-traumatic stress disorder (PTSD) is a mental health disorder with a lifetime prevalence of 3.9% (Koenen et al, 2017)
We examined the prospective relationship between prenatal insomnia symptoms and subsequent childbirth-related PTSD (CB-PTSD) symptoms
Piecewise structural equation modelling Because several causal hypotheses involving a set of potentially mediating/moderating variables were to be tested in this study, a Structural Equation Modelling approach was adopted (Ullman and Bentler, 2003) using R version 4.0.4 (R Core Team, 2021)

Summary

Introduction

Triggered by a traumatic experience, post-traumatic stress disorder (PTSD) is a mental health disorder with a lifetime prevalence of 3.9% (Koenen et al, 2017). Its four symptoms clusters, which have to be present at least one month post-trauma, are: re-experiencing symptoms (including distressing trauma-related dreams), avoidance of trauma-related stimuli, alterations in arousal (including sleep distur bances), and negative cognitions and mood (American Psychiatric As sociation, 2013) Certain populations, such as service members, are at increased risk of experiencing a traumatic event and developing PTSD (Stefanovics et al, 2020). This is the case for women during the perinatal period, given that childbirth-related PTSD (CB-PTSD) affects 4% of mothers in community samples, and 18.5% in high-risk samples (Yildiz et al, 2017) Overall, these groups would benefit from primary preventive interventions for PTSD, but they are lacking (Howlett and Stein, 2016). Even beyond the perinatal context, future studies on pre-traumatic insomnia and PTSD should include post-traumatic insomnia as a covariate

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Conclusion