Review confirms that perinatal PTSD is common enough to be significant public health concern that warrants routine screening and treatment.

Published (Updated )

A new paper from academics at City, University of London shows that between 3% and 4% of women report post-traumatic stress disorder (PTSD) in pregnancy and after birth.

The review also confirms that perinatal PTSD – which refers to the period before and just after birth - is common enough to be significant public health concern that warrants routine screening and treatment and that PTSD may also increase after birth if not identified and treated.

As a result, it is important to not only increase awareness but also provide ongoing assessment during this period. This could be achieved through self-report questionnaires as they were found to provide broadly similar prevalence rates to clinical interviews. While not the gold standard they may be a useful first step for identifying perinatal PTSD.

In the UK, up to 700,000 women give birth each year meaning approximately 28,000 women could be affected if the prevalence is assumed to be 4%. The PTSD rates are even more striking in high-risk people, and were found to be between 4% and 6% in women who experience severe complications during pregnancy or birth, or whose babies are born preterm or need intensive care treatment.

PTSD can be present in pregnancy as a result of traumatic events such as accidents, violence or natural disasters. Following childbirth, PTSD can also develop after a difficult or traumatic birth during which women think they or their baby might die or be seriously hurt. If women have a history of PTSD it is also possible this can be re-triggered by events during pregnancy and birth.

A number of previous studies have also shown that PTSD can have a negative impact on women, their relationship and birth outcomes. To investigate the prevalence of PTSD pre- and post-birth, the City researchers found 59 research studies involving a total of 24267 women that reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure. Of these 59 studies it included 35 studies of prenatal PTSD and 28 studies of after birth PTSD (where 4 studies provided prevalence of PTSD in pregnancy and after birth).

The results show the prevalence of PTSD in pregnancy was 3.3% in community samples and 18.95% in high-risk samples. After birth, the prevalence of PTSD was 4.0% in community samples and 18.5% in high risk samples. Given the mean point prevalence of PTSD, the course of PTSD over the first six months after birth suggests it increases slightly in both community samples and high risk samples.

The result of this review suggests that the mean PTSD rates are somewhat higher immediately after birth than in pregnancy. This might be due to difficult childbirth experiences triggering the development of a new episode of PTSD or exacerbating existing PTSD present in pregnancy. Alternatively, childbirth might be a trigger for women with a history of trauma and prior PTSD, which could then re-occur in the after birth period.

This differing course of PTSD in after birth women might be due to unique elements of the period after birth which might delay symptom onset and/or prevent resolution, such as coping with a new baby and sleep deprivation.

Given the association of PTSD with poor maternal outcomes there are also a number of significant implications for health services and clinical practice. As a result it is important for the psychological assessment of pregnant and after birth women for PTSD, particularly those with high-risk conditions is vital to identify and treat women with PTSD. Routine screening of high-risk perinatal women would be ideal and strongly recommended.

Notably in clinical settings where the demand is high and clinicians’ time is limited, using valid and reliable self-report questionnaires may provide a useful first step that supplements

clinicians’ assessment. Women identified as having high levels of symptoms could then be referred on for further mental health evaluation.

Professor Susan Ayers, Professor of Maternal and Child Health at City, University of London, said:

"Our new review has shown that as many as 42,000 women could be affected by PTSD every year. This is a huge number of affected families and couples and much needs to be done to not only raise awareness of this disorder but also increase mental health provision for mothers during pregnancy and after birth as this prevents a very real public health challenge.

This is compounded by the fact that our study revealed that over the first six months after birth PTSD increases in both community and high-risk samples. As a result we need to act now to ensure that women receive the support they need, especially considering the long-term impact on women and their families."

Post-traumatic stress in pregnancy and childbirth: City, University of London - shaping opinion