The effects of PTSD treatment during pregnancy: systematic review and case study

Abstract

Background: PTSD in pregnant women is associated with adverse outcomes for mothers and their children. It is unknown whether pregnant women with PTSD, or symptoms of PTSD, can receive targeted treatment that is safe and effective. Objective: The purpose of the present paper was to assess the effectiveness and safety of treatment for (symptoms of) PTSD in pregnant women. Method: A systematic review was conducted in accordance with the PRISMA guidelines in Pubmed, Embase, PsychINFO, and Cochrane. In addition, a case is presented of a pregnant woman with PTSD who received eye-movement desensitization and reprocessing (EMDR) therapy aimed at processing the memories of a previous distressing childbirth. Results: In total, 13 studies were included, involving eight types of interventions (i.e. trauma-focused cognitive behavioural therapy, exposure therapy, EMDR therapy, interpersonal psychotherapy, explorative therapy, self-hypnosis and relaxation, Survivor Moms Companion, and Seeking Safety Intervention). In three studies, the traumatic event pertained to a previous childbirth. Five studies reported obstetrical outcomes. After requesting additional information, authors of five studies indicated an absence of serious adverse events. PTSD symptoms improved in 10 studies. However, most studies carried a high risk of bias. In our case study, a pregnant woman with a PTSD diagnosis based on DSM-5 no longer fulfilled the criteria of PTSD after three sessions of EMDR therapy. She had an uncomplicated pregnancy and delivery. Conclusion: Despite the fact that case studies as the one presented here report no adverse events, and treatment is likely safe, due to the poor methodological quality of most studies it is impossible to allow inferences on the effects of any particular treatment of PTSD (symptoms) during pregnancy. Yet, given the elevated maternal stress and cortisol levels in pregnant women with PTSD, and the fact that so far no adverse effects on the unborn child have been reported associated with the application of trauma-focused therapy, treatment of PTSD during pregnancy is most likely safe. Los efectos del tratamiento del TEPT durante el embarazo: revisión sistemática y estudio de caso Antecedentes: El TEPT en mujeres embarazadas se asocia con consecuencias adversas para las madres y sus hijos. Se desconoce si las mujeres que están embarazadas y sufren de TEPT, o síntomas de TEPT, pueden recibir un tratamiento dirigido que sea seguro y efectivo. Objetivo: El objetivo del presente trabajo fue evaluar la efectividad y la seguridad del tratamiento para (síntomas de) TEPT en mujeres embarazadas. Método: Se realizó una revisión sistemática de acuerdo con las directrices PRISMA en Pubmed, Embase, PsychINFO y Cochrane. Además, se presenta un caso de una mujer embarazada con TEPT que recibió terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) destinada a procesar los recuerdos de un parto traumático anterior. Resultados: En total, se incluyeron 13 estudios, que incluyeron ocho tipos de intervencion...

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

“…Similar to previous reviews (Nillni et al., 2018; Baas et al., 2020), we found no open trials or RCTs of exposure therapies for PTSD during pregnancy. The reasons for this may be related to a fear of stressing the pregnant woman or fetus via transient increased physiological arousal, in addition to the widespread pattern of excluding pregnant women from clinical research in general (Arch et al., 2012; Blehar et al., 2013).…”

“…There is a dearth of research examining psychological interventions and treatment for PTSD symptoms among pregnant women, although the studies included in the present review provide promising avenues for further inquiry. Extending the findings of previous reviews of interventions targeting PTSD symptoms during the perinatal period (Nillni et al., 2018; Baas et al., 2020), the current review found preliminary evidence that community health workers without specialized training in mental health treatment, such as prenatal advocates in the SS intervention or “tutors” in the SMC intervention, can effectively deliver psychoeducation interventions for pregnant, trauma‐exposed women with PTSD symptoms. Psychoeducation interventions for pregnant women with PTSD symptoms may be acceptable, feasible, and associated with improved perinatal outcomes, as evidenced by studies on SS and SMC (Rowe et al., 2014; Sperlich et al., 2011; Upshur et al., 2016; Weinreb et al., 2018).…”

“…The present study extends the work of previous systematic reviews that have covered the topic of perinatal mood, anxiety, and trauma‐related disorder treatments (Nillni et al., 2018) and perinatal PTSD (Baas et al, 2020). Whereas the previous reviews have either examined studies of individuals who met the full diagnostic criteria for PTSD (Nillni et al., 2018) or adopted a broader approach by including studies that reported on PTSD symptom change from pregnancy to the postpartum period (Baas et al., 2020), the present review focused on studies in which interventions and/or treatments examined (a) the results for both subthreshold and full threshold PTSD symptoms and (b) pre‐ and postassessments during pregnancy to evaluate an intervention's effect on PTSD symptoms that were present specifically during the gestational period of pregnancy. The aims of the current study were to (a) review the literature on the effectiveness of psychological interventions and treatments for prenatal PTSD symptoms conducted during pregnancy and (b) identify gaps in the existing literature to provide recommendations for future research, including methodological and study design considerations.…”

“…Although the extant research highlights a critical need for the detection, intervention, and treatment of prenatal PTSD, few studies have examined interventions for trauma‐related symptoms during the perinatal period (Nillni et al., 2018; Baas et al., 2020). In contrast, a recent review cited 14 trials of psychotherapy treatment for depression during pregnancy (Nillni et al., 2018).…”

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

“…Inclusion criteria were: 1) ages 18 to 65 years; 2) a PTSD diagnosis according to the DSM-5 classification established with the Clinician-Administered PTSD Scale (CAPS-5 see below), and at least moderate severity of PTSD-symptoms (CAPS-5 score ≥26) and at least one specific memory of the traumatic event; 3) Traumata related to childhood sexual and/or physical abuse that occurred before 18 years of age, committed by a primary caretaker or an authority figure as index event; 4) sufficient fluency in Dutch to complete the treatment and research protocols. Exclusion criteria were: 1) involvement in a compensation case or legal procedures concerning admission or stay in The Netherlands; 2) pregnancy given the limited available information about safety (Baas, van Pampus, Braam, Stramrood, & de Jongh, 2020), 3) severe nonsuicidal self-injury (NSSI) which required hospitalization during the past 3 months; 4) severe suicidal behaviour: a suicide attempt during the past 3 months or acute suicidal ideations with serious intent to die with a specific plan for suicide and preparatory acts; 5) severe disorder in the use of alcohol or drugs in last 3 months according to the Mini-International Neuropsychiatric Interview (MINI; Sheehan et al, 1998), 6) cognitive impairment (estimated IQ < 70); 7) changes in psychotropic medication in the 2 months prior to inclusion; and 8) engagement in any current psychological treatment. Written informed consent was obtained from all patients after receiving a complete description of the study.…”