Elaboration and Validation of Two Predictive Models of Postpartum Traumatic Stress Disorder Risk Formed by Variables Related to the Birth Process: A Retrospective Cohort Study

Abstract

This study aimed to develop and validate two predictive models of postpartum post-traumatic stress disorder (PTSD) risk using a retrospective cohort study of women who gave birth between 2018 and 2019 in Spain. The predictive models were developed using a referral cohort of 1752 women (2/3) and were validated on a cohort of 875 women (1/3). The predictive factors in model A were delivery type, skin-to-skin contact, admission of newborn to care unit, presence of a severe tear, type of infant feeding at discharge, postpartum hospital readmission. The area under curve (AUC) of the receiver operating characteristic (ROC) in the referral cohort was 0.70 (95% CI: 0.67–0.74), while in the validation cohort, it was 0.69 (95% CI: 0.63–0.75). The predictive factors in model B were delivery type, admission of newborn to care unit, type of infant feeding at discharge, postpartum hospital readmission, partner support, and the perception of adequate respect from health professionals. The predictive capacity of model B in both the referral cohort and the validation cohort was superior to model A with an AUC-ROC of 0.82 (95% CI: 0.79–0.85) and 0.83 (95% CI: 0.78–0.87), respectively. A predictive model (model B) formed by clinical variables and the perception of partner support and appropriate treatment by health professionals had a good predictive capacity in both the referral and validation cohorts. This model is preferred over the model (model A) that was formed exclusively by clinical variables.

The Impact of Mode of Birth on Childbirth-Related Post Traumatic Stress Symptoms beyond 6 Months Postpartum: An Integrative Review

“…Six studies differentiated between vaginal birth, operative vaginal birth and CS [ 37 , 38 , 58 , 59 , 60 , 61 ], whereas three studies differentiated between vaginal birth, elective caesarean section (elective CS) and emergency CS [ 62 , 63 , 64 ]. Eleven studies distinguished between vaginal birth, operative vaginal birth, elective CS and emergency CS [ 18 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. The two qualitative studies described women’s experiences after vaginal birth and CS [ 1 , 9 ].…”

“…For the detailed information about the included studies see Table 1 . In total twelve studies examined (crude or adjusted) associations between mode of birth and CB-PTS/D [ 22 , 36 , 37 , 38 , 58 , 59 , 61 , 66 , 70 , 72 , 73 , 75 ] ( Figure 3 ).…”

“…Eight studies indicated that operative vaginal birth was associated with CB-PTS/D, compared with spontaneous vaginal birth [ 36 , 37 , 38 , 58 , 66 , 70 , 72 , 75 ]. Four of those studies found an association between operative vaginal birth and CB-PTS/D in the univariate analyses, but this association was no longer significant after controlling for confounders such as social behavioral variables [ 36 , 66 , 70 , 75 ].…”

Measuring Risk Perception in Pregnant Women in Heavily Polluted Areas: A New Methodological Approach from the NEHO Birth Cohort

“…In human biomonitoring research, studies on mothers' RP usually refer to risks directly related to motherhood and childbirth, exploring particular aspects such as attitudes to vaccination, postpartum depression and anxiety, and perception of pain. In most of these works, the concept of perception is used as a synonym for awareness, recognition, discernment, and understanding [18][19][20][21][22].…”

The Relegated Goal of Health Institutions: Sexual and Reproductive Health

“…Postpartum post-traumatic stress disorder is an increasingly attention-grabbing disorder. For this reason, predictive models are useful, such as the one developed by Hernandez-Martinez et al that helps to predict the risk of this disease [15]. Prenatal care is essential, but it is not practised in the same way in all areas or by all women.…”