Trajectories of childbirth-related posttraumatic stress symptoms after a vaginal delivery: a multicenter prospective study.
Alizée Froeliger, Catherine Deneux-Tharaux, Lola Loussert et al.
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In 30 seconds
This multicenter prospective ancillary cohort study characterized childbirth-related posttraumatic stress symptom trajectories among women delivering vaginally after 35 weeks at 15 French university hospitals. Symptoms were assessed at day 2 and 2 months postpartum. After correction for nonresponse, 83.4% were asymptomatic, 11.0% recovered, 2.1% had emerging symptoms, and 3.5% had persistent symptoms; thus, about 1 in 20 had an unfavorable trajectory. Persistent symptoms were associated with preexisting vulnerabilities, bad delivery memories, and postpartum anemia, while emerging symptoms were associated with several obstetric factors.
Key findings
- Corrected prevalences were 83.4% asymptomatic, 11.0% recovered, 2.1% emerging, and 3.5% persistent symptom trajectories.
- Persistent symptoms versus recovery were associated with psychiatric history (adjusted odds ratio, 1.9; 95% confidence interval, 1.2-2.4) and hemoglobin <9 g/dL at day 2 (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.7).
- Emerging symptoms were associated with labor induction (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.8) and bad delivery memories (adjusted odds ratio, 3.7; 95% confidence interval, 1.4-5.6).
- Among women without symptoms at day 2, epidural analgesia was associated with lower odds of emerging symptoms (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.7).
Why it matters
Symptoms after childbirth do not follow a single course: some resolve, while others emerge after an initially symptom-free assessment or persist. Recognizing these distinct trajectories and their associated factors may help inform postpartum screening strategies and identify potential targets for preventive efforts, while the observational associations do not establish that any factor causes symptoms.
What to keep in mind
Only 2344 of 3891 women completed both symptom assessments; prevalences were corrected for nonresponse using inverse probability weighting. The study assessed symptoms through 2 months postpartum, not longer-term outcomes.