PTSD Symptoms Across Pregnancy and Early Postpartum Among Women With Lifetime PTSD Diagnosis

Abstract

Background Little is known about trajectories of PTSD symptoms across the peripartum period in women with trauma histories, specifically those who met lifetime PTSD diagnoses prior to pregnancy. The present study seeks to identify factors that influence PTSD symptom load across pregnancy and early postpartum, and study its impact on postpartum adaptation. Method The current study is a secondary analysis on pregnant women with a Lifetime PTSD diagnosis (N=319) derived from a larger community sample who were interviewed twice across pregnancy (28 and 35 weeks) and again at 6 weeks postpartum, assessing socioeconomic risks, mental health, past and ongoing trauma exposure, and adaptation to postpartum. Results Using trajectory analysis, first we examined the natural course of PTSD symptoms based on patterns across peripartum, and found 4 distinct trajectory groups. Secondly, we explored factors (demographic, historical, and gestational) that shape the PTSD symptom trajectories, and examined the impact of trajectory membership on maternal postpartum adaptation. We found that child abuse history, demographic risk, and lifetime PTSD symptom count increased pregnancy-onset PTSD risk, whereas gestational PTSD symptom trajectory was best predicted by interim trauma and labor anxiety. Women with the greatest PTSD symptom rise during pregnancy were most likely to suffer postpartum depression and reported greatest bonding impairment with their infants at 6 weeks postpartum. Conclusions Screening for modifiable risks (interpersonal trauma exposure and labor anxiety) and/or PTSD symptom load during pregnancy appears critical to promote maternal wellbeing.

Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment

“…These chronic-high mothers, not surprisingly, also had the highest rates of PTSD and depression diagnoses across the 4-to-18 months postpartum time span. In addition, 95% of these mothers had met diagnosis for the lifetime PTSD prior to pregnancy, supporting previously reported notion that lifetime PTSD is a major risk factor for reoccurrence of PTSD symptoms in postpartum (Breslau, Peterson & Schultz, 2008; Muzik et al, 2016). PTSD often exhibits chronic course with fluctuating symptom severity that can be exacerbated by re-exposure to traumatic/stressful events (Breslau & Peterson, 2010).…”

“…A study examining PTSD and depression among healthy adults showed a greater prevalence of PTSD (81.9% of those with PTSD) and a higher comorbidity rate (84.4%) among women with childhood abuse (Spinhoven, Penninx, van Hemert, de Rooij, & Elzinga, 2014). Few studies examined longitudinal peripartum symptomatology of PTSD and/or depression and found an overall declining trend of both conditions from 37 weeks gestation to 6 weeks postpartum in community samples (Onoye et al 2013; Muzik et al, 2016), noting considerable variability in longitudinal symptom progression. To capture such variation in co-occurring changes of postpartum depression and PTSD, a simultaneous, group-based trajectory analysis is warranted to identify subgroups with similar change patterns (e.g., joined linear decline, incline, no change, or mixed on both).…”

“…Research modeling postpartum depression and PTSD separately has demonstrated contextual and individual factors may account for distinct patterns (Campbell et al, 2007; Seng et al, 2013). Contextual factors including childhood trauma and trauma during pregnancy are risks for postpartum depression and/or PTSD (Berntsen et al, 2012; Cerulli, Talbot, Tang, & Chaudron, 2011; Onoye et al, 2013; Muzik et al, 2016). Social support is also found to facilitate symptom prognosis (Pietrzak et al, 2010) and postpartum adjustment (Montmasson, Bertrand, Perrotin, & El-Hage, 2012).…”

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms

“…In turn, poverty in adulthood is one of the most consistent predictors of depression symptom severity (e.g., Kosidou et al 2011), as well as of depression specifically in postpartum (Patel et al, 2002). Women with CM histories, especially those with demographic risk (e.g., low income), and with preexisting mental illness, are at greatest risk for postpartum symptom relapse (Muzik et al, 2016). Several investigations of CM survivors also find social support mediates the relationship between childhood maltreatment and later adjustment, particularly for women (e.g.…”

Understanding Bidirectional Mother-Infant Affective Displays across Contexts: Effects of Maternal Maltreatment History and Postpartum Depression and PTSD Symptoms

“…Mothers who have experienced childhood maltreatment are more likely than mothers without maltreatment histories to be at risk for postpartum depression and PTSD symptoms [10–12], and their infants are more likely to show less optimal behavioral and biological (cortisol) stress regulation [13]. While genetic and epigenetic factors may account for part of this intergenerational transmission [14], it is also possible that alteration in mother-infant affective exchanges during postpartum contribute to such outcomes.…”