Psychological Intervention and Treatment for Posttraumatic Stress Disorder During Pregnancy: A Systematic Review and Call to Action

Abstract

Posttraumatic stress disorder (PTSD) during pregnancy is a significant global mental health concern that affects up to 1 in 5 trauma‐exposed pregnant women and is associated with an increased risk of adverse maternal and infant complications and health outcomes. This systematic literature review, conducted in accordance with PRISMA guidelines, examined findings from studies of psychological interventions and treatments for prenatal PTSD to inform recommendations for future research. Relevant evidence was identified from reference reviews and electronic databases (i.e., PubMed, Google Scholar, PsychInfo, and Scopus). Included studies reported on the effect of nonpharmacological intervention or treatment of PTSD symptomatology delivered during pregnancy, with at least one postintervention follow‐up collected during pregnancy to assess prenatal treatment outcomes. The systematic review was augmented with a discussion of lower‐level evidence. Of the 954 articles screened, six peer‐reviewed, quantitative reports met the inclusion criteria and featured three empirically based interventions, including two randomized controlled trials: Two psychoeducation interventions for PTSD and one treatment study of interpersonal psychotherapy in trauma‐exposed pregnant women. Effect sizes for PTSD symptom change ranged from small to large, Cohen's d/ηp2 = 0.16–0.78. No studies examined evidence‐based PTSD treatments (e.g., exposure therapy, cognitive processing therapy). A risk of bias assessment indicated variability in study quality. This review demonstrates that research on prenatal PTSD symptoms, diagnosis, and treatment is extremely limited despite a clear link between prenatal PTSD and perinatal complications. Early evidence supports further scientific inquiry into psychoeducation, psychotherapy treatments (e.g., exposure therapy), integrated prenatal care approaches, and community‐based approaches.

Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy

“…Psychotherapeutic treatment for PTSD has been established as a safe option for pregnant individuals, ( 65 , 66 ) despite commonly held beliefs that discussing trauma may be stressful and thus detrimental to an expectant mother or her child ( 67 ). However, few studies include pregnant women in research investigating psychotherapeutic treatments for PTSD, ( 68 , 69 ) and even fewer specifically target perinatal PTSD or pPTSD ( 42 , 66 ).…”

“…Prenatal interventions for PTSD have largely been neglected in favor of screening and treatment efforts for post-partum depression ( 42 , 66 ). Perinatal PTSD is undetected and untreated in the vast majority of women, ( 10 , 75 ) and pPTSD may be even more overlooked.…”

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

“…Knowledge of PTSD prior to or during pregnancy that is also associated with a higher risk of traumatic birth experience (e.g., experience of fear, helplessness or horror, or re-experiencing delivery) is crucial for health-care providers to be alert of when they treat these high-risk women (20,76). Moreover, trauma-informed interventions should be developed and tested especially for women with PTSD and a history of interpersonal trauma or comorbid depression (74,77). Targets that should be addressed are prevention of re-traumatization during delivery, improvement of maternal partnership problems and social support, and sensitivity training to encourage mother-childinteraction and bonding/ attachment (78)(79)(80).…”

“…However, screening without sufficient services is not helpful and could be triggering for both professionals and families. Thus, a fully trauma informed perinatal system and effective trauma specific interventions during pregnancy and immediately after traumatic births is warranted to ensure that the families receive help for parenting and early bonding (77).…”

Using Theories of Posttraumatic Stress to Inform Perinatal Care Clinician Responses to Trauma Reactions

“…Several more formal programs have been developed, which can be offered to individuals or groups (eg, Seeking Safety , Survivor Moms’ Companion ) 42,51 . To date, these programs have been the subject of pilot studies, evaluation, and implementation reports but have not been fully evaluated for effectiveness 52,53 . Trauma‐specific programs can be implemented at the practice, hospital, or community level.…”