Prevalence, Trauma History, and Risk for Posttraumatic Stress Disorder Among Nulliparous Women in Maternity Care

Abstract

Objective To estimate point prevalence and assess the association of types of trauma with posttraumatic stress disorder (PTSD) in a sociodemographically and racially mixed sample of women from both predominantly Medicaid and privately insured settings expecting their first infant. Methods Structured telephone diagnostic interview data were analyzed for prevalence of trauma exposure, PTSD, comorbidity, risk behaviors, and treatment-seeking among 1,581 diverse English-speaking nulliparous women. Results The overall rate of lifetime PTSD was 20.2%, 17% in the predominantly private-payer settings, 23% in the predominantly public-payer settings. The overall rate of current PTSD was 7.9%, 2.9% and 13.9% respectively. Those with current PTSD were more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher crime areas. Adjusted odds of having current PTSD were highest among those whose worst trauma exposure was abuse (OR = 11.9, 95% CI 3.6, 39.9), followed by reproductive trauma (OR = 6.1, 95% CI 1.5, 24.4). Health risk behaviors and exposures were concentrated among those with PTSD. Conclusion These findings affirm that PTSD affects pregnant women. Women with PTSD in pregnancy were more like to have had exposures to childhood abuse and prior traumatic reproductive event, to have cumulative sociodemographic risk factors, comorbid depression and anxiety, and to have sought mental health treatment in the past. Obstetric risk behaviors occur more in women with PTSD. Research is needed to assess the effect of PTSD, a potentially modifiable source of perinatal morbidity, on obstetric outcomes.

Placenta accreta is associated with IVF pregnancies: a retrospective chart review

“…1 Regarding the first comment, that our results are biased by the high rate of caesarean delivery among the study group, if this finding did introduce bias into the results it would be to a small extent because the rate of caesarean section among this group was less than four-fold of that of the control spontaneous pregnancies. Conversely, the rate of placenta accreta was increased 13-fold.…”

“…The prevalence of prenatal PTSD ranges from 3.5% in a sample with a 29% trauma rate to 16% in a sample with a 60% rate of abuse. 1 We found an 8% prevalence overall, but defined a range from 2.9% in the private sector to 13.9% in the public sector. The highly sensitive trauma measure we used did not seem to inflate PTSD rates, as less severe trauma exposures were rarely antecedents to PTSD diagnosis (e.g.…”

“…j Sir, I read with interest the article by Esh-Broder and colleagues 1 and noted that one of the triggers for performing placental histology was 'in caesarean sections, cases with heavy bleeding from the vaginal bed'. As the incidence of caesarean section was greater in the in vitro fertilisation (IVF) group, their findings could partly be explained by an increase in the percentage of placentas examined in the IVF Placenta accreta is associated with IVF pregnancies: a retrospective chart review…”

“…Childhood maltreatment conveyed the greatest risk (OR 11.9, 95% CI 3.6-39.9) for PTSD in pregnancy. 1 We chose the National Women's Study PTSD module, a goldstandard structured diagnostic interview used in the largest study of PTSD in women from the USA, so that we could compare symptom profiles of our pregnant sample with 2000 women of childbearing age from the nationally representative sample. We concluded that pregnant women reported symptoms that were specific to traumatic stress.…”

Childbirth related fears and psychological birth trauma in younger and older age adolescents

“…Younger age, abuse and depression have been recognized to associate with PTSD among adult childbearing women (Seng, Low, Sperlich, Ronis, & Liberzon, 2009). Symptoms of PTSD postpartum can occur without a prior history of trauma or depression during pregnancy (Alcorn et al, 2010); however, the prevalence of abuse and depression among adolescents may heighten their vulnerability to PBT, especially PTSD.…”