The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis

Pelin Dikmen Yildiz,Susan Ayers,Louise Phillips

doi:10.1016/j.jad.2016.10.009

Abstract

BackgroundPrevious reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time. MethodsPsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. Results59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44–4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77–5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62–31.43) in pregnancy and 18.5% (95%, CI 10.6–30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum. LimitationsLimitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters. ConclusionsPTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.

Highlights

Up to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience
It is hypothesized that early intervention eye movement desensitization and reprocessing (EMDR) therapy is safe and that women who receive early intervention EMDR will report significantly less PTSD 9 weeks after the delivery compared to women who receive no treatment
The PERCEIVE study will be the first randomized controlled trial that examines the safety and effectiveness of early EMDR therapy in preventing or reducing PTSD in women with a traumatic birth experience. We consider this of great importance given the major impact of PTSD on both mother and infant found in the literature [14,15,16,17]

Summary

Introduction

Up to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience. Little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience. According to recent meta-analyses, 3–4% of all women develop PTSD following childbirth [1, 2] while up to 33% of women experience symptoms of PTSD [3, 4]. Risk factors for a traumatic birth experience are diverse. Prevalence of traumatic birth experiences has been found to be higher among women with unexpected interventions during labour and delivery, such as unplanned caesarean section or vacuum-assisted delivery [3, 5]. Other reported risk factors include a history of psychiatric illness, previous trauma, fear of childbirth (FoC) and preeclampsia [2, 5]

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