About ten percent of women may develop PTSD at two months after cesarean delivery: Study

Researchers have found that cesarean deliveries may affect maternal mental health to a great extent, as almost 1 in 11 women may show symptoms of posttraumatic stress disorder (PTSD) two months after giving birth. A recent study was published in the American Journal of Obstetrics and Gynecology conducted by Alizee F. and colleagues.

The TRAAP2 study was a prospective ancillary cohort research study which aimed to inform the way cesarean delivery relates to PTSD symptoms and actual diagnoses. The study was conducted from 2018 to 2020 in 27 French hospitals on women scheduled for cesarean delivery at or beyond 34 weeks of gestation. The prevalence of PTSD two months postpartum was evaluated using the Self-reported Impact of Event Scale – Revised (IES-R) and Traumatic Event Scale (TES) questionnaires. Nonresponse was addressed by using inverse probability weighting for increased precision.

The study involved 4431 women who were to be delivered via cesarean section either pre-planned or in labor. Analysis of responses was conducted from 2785 participants who responded to the IES-R and 2792 participants who responded to the TES. The study only analyzed participants who did not have risk factors and whose data was not missing. Logistic and linear regression models were applied to find possible associations between cesarean delivery experiences and risk for PTSD.

  • Of the participants who completed the IES-R, 9% exhibited symptoms of PTSD as measured by their scores.

  • Moreover, 1.7% fulfilled provisional criteria as given by the diagnostic algorithm in terms of achieving a diagnosis of PTSD.

  • There were several prepregnancy risk factors identified in this study. These included younger age, higher BMI, and an African-born migrant.

  • There was a strong association among these factors and PTSD presence following a cesarean delivery.

There were some cesarean delivery risk factors that increased the risk for PTSD:

  • Women who received a cesarean after an induction of labour had an increased risk of 1.81 times the presence of PTSD (95% CI, 1.14–2.87).

  • Participants who experienced severe bleeding at the time of delivery were found to have 1.61-fold risk in the development of PTSD, compared with controls (95% CI, 1.04–2.46).

  • Women with significant pain during the postpartum period had 1.90 times higher risk of developing PTSD (95% CI, 1.17–3.11).

  • Immediate skin-to-skin contact with newborns showed a protective effect, reducing PTSD risk (OR, 0.66; 95% CI, 0.46–0.98).

  • Negative memories of the delivery experience by day two postpartum increased PTSD risk significantly (OR, 3.20; 95% CI, 1.97–5.12).

Women who deliver via cesarean may develop symptoms of PTSD postpartum, and enhanced support and mental health interventions during postpartum care could reduce some risks associated with childbirth trauma. This study shows the importance of considering maternal mental health in recovery from childbirth, especially for those pregnant women who underwent cesarean delivery under emotionally challenging conditions.

Reference:

Froeliger, A., Deneux-Tharaux, C., Loussert, L., Madar, H., Sentilhes, L., Sentilhes, L., Senat, M. V., Le Lous, M., Winer, N., Rozenberg, P., Kayem, G., Verspyck, E., Fuchs, F., Azria, E., Gallot, D., Korb, D., Desbrière, R., Le Ray, C., Chauleur, C., … Deneux-Tharaux, C. (2024). Posttraumatic stress disorder 2 months after cesarean delivery: a multicenter prospective study. American Journal of Obstetrics and Gynecology, 231(5), 543.e1-543.e36. https://doi.org/10.1016/j.ajog.2024.03.011
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