Trajectories of childbirth-related posttraumatic stress symptoms after a vaginal delivery
Childbirth-related posttraumatic stress symptoms (PSS) may occur when childbirth is experienced as a traumatic event, yet their evolution during the first weeks after delivery remains poorly understood.
A multicenter prospective study, conducted as an ancillary cohort of the French TRAAP randomized trial across 15 university hospitals, aimed to characterize trajectories of childbirth-related PSS from postpartum day 2 to two months after vaginal delivery and to identify factors associated with unfavorable symptom trajectories.
The analysis included 2,344 women who delivered vaginally after 35 weeks of gestation and completed the Impact of Event Scale–Revised (IES-R), a validated self-administered measure of posttraumatic stress symptoms, at postpartum day 2 and again at two months. Four symptom trajectories were defined according to changes in IES-R scores over time: an asymptomatic trajectory, with no clinically significant symptoms at either assessment (IES-R <22); a recovery trajectory, with clinically significant symptoms at day 2 (IES-R ≥22) that resolved by two months (IES-R <22); an emerging trajectory, characterized by the onset of clinically significant symptoms at two months (IES-R ≥22) among women without symptoms at day 2; and a persistent trajectory, with clinically significant symptoms present at both assessments (IES-R ≥22).
After correction for potential nonresponse bias using inverse probability weighting, 83.4% of women followed an asymptomatic trajectory and 11.0% a recovery trajectory, whereas 2.1% followed an emerging trajectory and 3.5% a persistent trajectory.
Risk factors differed according to symptom trajectory. Among women with clinically significant symptoms at day 2, persistent symptoms at two months were associated with younger maternal age (adjusted OR [aOR] 0.8, 95% CI 0.6–0.9), birth outside Europe (aOR 1.8, 95% CI 1.2–2.6), a psychiatric history (aOR 1.9, 95% CI 1.2–2.4), negative memories of childbirth (aOR 2.4, 95% CI 1.3–4.6), and postpartum anemia with a hemoglobin level <9 g/dL at day 2 (aOR 1.8, 95% CI 1.1–2.7).
Among women without clinically significant symptoms immediately after delivery, symptom onset at two months was associated with a previous abortion (aOR 2.6, 95% CI 1.6–3.9), hospitalization during pregnancy (aOR 2.8, 95% CI 1.4–4.7), induction of labor (aOR 1.7, 95% CI 1.1–2.8), negative memories of childbirth (aOR 3.7, 95% CI 1.4–5.6), and marked fatigue at day 2 (aOR 2.2, 95% CI 1.4–3.5). Conversely, epidural analgesia was associated with a lower risk of an emerging trajectory (aOR 0.2, 95% CI 0.1–0.7).
Overall, approximately one in twenty women experienced an unfavorable trajectory of childbirth-related posttraumatic stress symptoms during the first two months after a term vaginal delivery. Persistent trajectories were primarily associated with preexisting vulnerabilities, negative childbirth experiences, and early postpartum anemia, whereas emerging trajectories were more closely associated with obstetric factors.
These findings support the implementation of staged screening for childbirth-related posttraumatic stress across pregnancy and the early postpartum period to identify women at risk of persistent or delayed-onset symptoms and to inform targeted prevention strategies following vaginal delivery.
- Alizée FROELIGER, Catherine DENEUX-THARAUX, Lola LOUSSERT, Anne Laure SUTTER-DALLAY, Hugo MADAR, Loïc SENTILHES
- https://www.sciencedirect.com/science/article/abs/pii/S0002937826003273
By Alizée FROELIGER
