Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one ...year postpartum) on child outcomes has not been systematically examined.
A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.
26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.
Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity.
Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
•Postpartum PTSD is associated with low birth weight and lower rates of breastfeeding.•Links with infant cortisol and eating/sleep problems are reported in single studies.•Mixed evidence for associations with preterm birth, fetal growth, head circumference.•Evidence regarding mother-infant interaction or child development is inconclusive.
Epidemics or pandemics, such as the current Coronavirus Disease 2019 (COVID-19) crisis, pose unique challenges to healthcare professionals (HCPs). Caring for patients during an epidemic/pandemic may ...impact negatively on the mental health of HCPs. There is a lack of evidence-based advice on what would be effective in mitigating this impact.
This rapid review synthesizes the evidence on the psychological impact of pandemics/epidemics on the mental health of HCPs, what factors predict this impact, and the evidence of prevention/intervention strategies to reduce this impact.
According to rapid review guidelines, systematic searches were carried out in Embase.com , PubMed, APA PsycINFO-Ovid SP, and Web of Science (core collection). Searches were restricted to the years 2003 or later to ensure inclusion of the most recent epidemic/pandemics, such as Severe Acute Respiratory Syndrome (SARS). Papers written in French or English, published in peer-reviewed journals, and of quantitative design using validated measures of mental health outcomes were included. Of 1308 papers found, 50 were included. The full protocol for this rapid review was registered with Prospero (reg.no. CRD42020175985).
Results show that exposed HCPs working with patients during an epidemic/pandemic are at heightened risk of mental health problems in the short and longer term, particularly: psychological distress, insomnia, alcohol/drug misuse, and symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, burnout, anger, and higher perceived stress. These mental health problems are predicted by organizational, social, personal, and psychological factors and may interfere with the quality of patient care. Few evidence-based early interventions exist so far.
HCPs need to be provided with psychosocial support to protect their mental wellbeing if they are to continue to provide high quality patient care. Several recommendations relevant during and after an epidemic/pandemic, such as COVID-19, and in preparation for a future outbreak, are proposed.
Gestational Diabetes Mellitus (GDM) is associated with future cardio-metabolic risks for the mother and her child. In addition, one-third of women with recent GDM develop postpartum depression. Given ...these adverse impacts of GDM on the health of the mother and her offspring, it is important to intervene on modifiable factors, such as diet, physical activity, and psychosocial well-being. This integrative review therefore explored evidence on how these modifiable factors interact in women with GDM and their offspring, and how effective combined interventions are on reducing adverse impacts of GDM.
A comprehensive search strategy included carefully selected terms that corresponded to the domains of interest (diet, physical activity and psychosocial well-being). The databases searched for articles published between 1980 and February 2018 were: CINAHL, PsycINFO, Embase, Pubmed and Cochrane. Studies that were included in this review were either observational or intervention studies that included at least two domains of interest. Articles had to at least report data on maternal outcomes of women with GDM.
The search strategies identified 14'419 citations after excluding duplicates. After screening titles and then abstracts, 114 articles were selected for detailed evaluation of their full text, and 16 were included in this review: two observational and 14 intervention studies. Results from observational studies showed that psychosocial well-being (social support and self-efficacy) were positively associated with physical activity and dietary choice. Intervention studies always included diet and physical activity interventions, although none integrated psychosocial well-being in the intervention. These lifestyle interventions mostly led to increased physical activity, improved diet and lower stress perception. Many of these lifestyle interventions also reduced BMI and postpartum diabetes status, improved metabolic outcomes and reduced the risk of preterm deliveries and low birth weight.
This integrative review showed that psychosocial well-being interacted with diet as well as with physical activity in women with GDM. We recommend that future studies consider integrating psychosocial well-being in their intervention, as observational studies demonstrated that social support and self-efficacy helped with adopting a healthy lifestyle following GDM diagnosis.
Intrusive memories of a traumatic event can be distressing and disruptive, and comprise a core clinical feature of post-traumatic stress disorder (PTSD). Intrusive memories involve mental ...imagery-based impressions that intrude into mind involuntarily, and are emotional. Here we consider how recent advances in cognitive science have fueled our understanding of the development and possible treatment of intrusive memories of trauma. We conducted a systematic literature search in PubMed, selecting articles published from 2008 to 2018 that used the terms “trauma” AND (“intrusive memories” OR “involuntary memories”) in their abstract or title. First, we discuss studies that investigated internal (neural, hormonal, psychophysiological, and cognitive) processes that contribute to intrusive memory development. Second, we discuss studies that targeted these processes using behavioural/pharmacological interventions to reduce intrusive memories. Third, we consider possible clinical implications of this work and highlight some emerging research avenues for treatment and prevention, supplemented by new data to examine some unanswered questions. In conclusion, we raise the possibility that intrusive memories comprise an alternative, possibly more focused, target in translational research endeavours, rather than only targeting overall symptoms of disorders such as PTSD. If so, relatively simple approaches could help to address the need for easy-to-deliver, widely-scalable trauma interventions.
•Intrusive memories of trauma can be distressing and disruptive in their own right.•Intrusive memories are a core clinical feature of posttraumatic stress disorder.•Cognitive science offers insights on the aetiology of intrusive memories.•Targeting intrusive memories has implications for prevention and scalable treatment.•Focusing on one symptom, instead of a whole disorder, has translational benefits.
Up to 30% of women view their childbirth as traumatic. This experience can lead to acute stress disorder or post-traumatic stress disorder. The negative impact of maternal post-traumatic stress ...disorder following childbirth reaches beyond the mother, potentially affecting her child's development and the couple's relationship. Research on
post-traumatic stress disorder following childbirth is scarce. Acute stress disorder is suggested to be an important predictor of post-traumatic stress disorder in mothers, but little is known about
acute stress disorder following childbirth. Furthermore, there is limited information about the comparison or relation of acute stress disorder and post-traumatic stress disorder following childbirth between parents.
1 To compare the prevalence rates and severity of acute stress disorder and post-traumatic stress disorder symptoms between parents following childbirth by taking anxiety and depression symptoms, as well as obstetric variables and previous traumatic events into account and 2 To determine if acute stress disorder is a predictor of post-traumatic stress disorder.
A prospective population-based design was used.
= 647 participants were recruited from future parents who attended appointments at the Obstetrics and Gynecology unit at a Swiss university hospital. Self-report questionnaires were used: Post-traumatic Diagnostic Scale in the third trimester of pregnancy (T1) and 1 month post-partum (T3), Acute Stress Disorder Scale at 1 week post-partum (T2), and Hospital Anxiety and Depression Scale at all time points. Obstetric and neonatal variables were retrieved from hospital records.
At T2, 63.9% of mothers and 51.7% of fathers presented symptoms of acute stress disorder. At T3, 20.7% of mothers and 7.2% of fathers had symptoms of post-traumatic stress disorder. Acute stress disorder was a predictor of post-partum post-traumatic stress disorder (Odds ratio: 8.6, IC 95% 1.85; 40.42). Depression symptoms was a significant confounder in the prediction of post-traumatic stress disorder following childbirth, but not anxiety or previous perinatal loss.
Little is known about parental differences in acute stress disorder and post-traumatic stress disorder symptoms following childbirth. Results indicate that
parents may suffer from acute stress disorder and post-traumatic stress disorder symptoms after childbirth and that acute stress disorder is a predictor of post-traumatic stress disorder after childbirth for both parents. Sensitization of maternity staff to these results may assist in earlier identification of and appropriate treatment for at-risk parents.
Abstract
Antenatal classes have evolved considerably and include now a discussion of the parents' birth plan. Respecting this plan normally results in a better childbirth experience, an important ...protective factor of post-traumatic stress disorder following childbirth (PTSD-FC). Antenatal class attendance may thus be associated with lower PTSD-FC rates. This cross-sectional study took place at a Swiss university hospital. All primiparous women who gave birth to singletons from 2018 to 2020 were invited to answer self-reported questionnaires. Data for childbirth experience, symptoms of PTSD-FC, neonatal, and obstetrical outcomes were compared between women who attended (AC) or not (NAC) antenatal classes. A total of 794/2876 (27.6%) women completed the online questionnaire. Antenatal class attendance was associated with a poorer childbirth experience (
p
= 0.03). When taking into account other significant predictors of childbirth experience, only induction of labor, use of forceps, emergency caesarean, and civil status remained in the final model of regression. Intrusion symptoms were more frequent in NAC group (M = 1.63 versus M = 1.11,
p
= 0.02). Antenatal class attendance, forceps, emergency caesarean, and hospitalisation in NICU remained significant predictors of intrusions for PTSD-FC. Use of epidural, obstetrical, and neonatal outcomes were similar for AC and NAC.
The possibility of posttraumatic growth in the aftermath of pregnancy loss has received limited attention to date. This study investigated posttraumatic growth in mothers following stillbirth ...compared to early miscarriage. It was hypothesised that mothers following stillbirth will demonstrate more posttraumatic growth, challenge to assumptive beliefs, and disclosure than mothers following early miscarriage. The study also sought to understand how theoretically-derived variables of the Model of Growth in Grief (challenge to assumptive beliefs and disclosure) explained unique variance in posttraumatic growth when key factors were controlled for. One-hundred and twenty women who had experienced a stillbirth (N = 57) or early miscarriage (N = 63) within the last two to six years completed validated questionnaires in an online survey relating to posttraumatic growth and key variables relevant to emotional adjustment post-bereavement. Participants who had experienced a stillbirth demonstrated significantly higher levels of posttraumatic growth, posttraumatic stress symptoms, perinatal grief, disclosure, challenge to assumptive beliefs and rumination than participants who had experienced an early miscarriage (Cohen's d ranged .38-.94). In a hierarchical stepwise regression analysis, challenge to assumptive beliefs alone predicted 17.5% of the variance in posttraumatic growth. Intrusive and deliberate rumination predicted an additional 5.5% of variance, with urge to talk, reluctance to talk, and actual self-disclosure predicting a further 15.3%. A final model including these variables explained 47.9% of the variance in posttraumatic growth. Interventions targeting challenge to assumptive beliefs, disclosure, and rumination are likely to be clinically useful to promote psychological adjustment in mothers who have experienced stillbirth and early miscarriage.
The parent-infant bond following childbirth is an important facilitator of optimal infant development. So far, research has mainly focused on mother-infant bonding. Data on fathers are still sparse. ...Parental mental health, such as posttraumatic stress symptoms (PTSD), may influence mother-infant relations and/or interactions. There is evidence that both parents can experience PTSD symptoms following childbirth (PTSD-CB). The aim of this study is to investigate the prospective relationship between parental PTSD-CB symptoms at 1 month postpartum and perceived parent-infant bonding at 3 months postpartum, while adjusting for antenatal confounders. A subsample was used for this study (
488,
= 356,
= 132) of an ongoing prospective cohort study. Future parents awaiting their third trimester antenatal appointments at a Swiss university hospital were recruited. Self-report questionnaires assessed PTSD-CB symptoms and psychological distress at 1 month postpartum, and parent-infant bonding at 3 months postpartum. Confounders included antenatal PTSD symptoms and social support measured
self-report questionnaires, and gestity and gestational age, extracted from medical records. Using structural equation modeling, the predictive ability of PTSD-CB symptoms at 1 month postpartum on parent-infant bonding at 3 months postpartum was assessed for both parents respectively. Maternal PTSD-CB symptoms at 1 month postpartum were found to be negatively prospectively associated with mother-infant bonding at 3 months postpartum; however, this effect disappeared after adjusting for psychological distress at 1 month postpartum. No such effects were found for fathers. There was no evidence of mediation of the relationship between parental PTSD-CB symptoms at 1 month postpartum and parental-infant bonding at 3 months postpartum
psychological distress at 1 month postpartum. However, such a mediation was found for maternal intrusion and hyperarousal symptom subscales. Results expand the current literature on the impact of PTSD-CB on parent-child relations to also include fathers, and to a community sample. Any adverse effects of mental health symptoms on parent-infant bonding were evidenced by 3 months postpartum only for mothers, not fathers. Our results may inform the development of prevention/intervention strategies.
We evaluated the associations between intuitive eating during and after pregnancy with metabolic health at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational ...diabetes mellitus subgroups. One hundred seventeen women who consented and completed the French intuitive eating questionnaire during and after pregnancy were included. We found an association between intuitive eating during and after pregnancy with lower body mass index, weight retention, fasting glucose, and HbA1c at 1-year postpartum in women with gestational diabetes mellitus and in high-risk gestational diabetes mellitus subgroups with overweight/obese or with prediabetes in the postpartum period. Our results suggest that intuitive eating could be an effective intervention for weight and glucose control in women with gestational diabetes mellitus.
The couple relationship is of particular importance in the transition to parenthood and in the early childhood years because it is related to the well-being and mental health of partners, children, ...and the family. One factor that may substantially influence relationship quality and couple satisfaction after childbirth is the woman's experience of birth. Approximately 2-4% of women develop posttraumatic stress disorder (PTSD) after childbirth, with potentially wide-ranging negative consequences for the women themselves and their families. To date, some qualitative studies have explored the influence of postpartum PTSD on couple relationship satisfaction. However, quantitative studies are sparse, with mixed results and methodological limitations. We hypothesized that postpartum PTSD will be prospectively associated with low couple relationship satisfaction, even when taking into account a variety of potential confounding variables, and that the effect of postpartum PTSD symptoms on couple relationship satisfaction will be mediated by postpartum depression symptoms. This study is based on data from the Akershus Birth Cohort study, a prospective cohort study. Information from hospital records and questionnaires completed at 17 weeks gestational age, as well as at 8 weeks and 2 years postpartum were used (
= 1480). PTSD symptoms were measured by the Impact of Event Scale and couple relationship satisfaction was assessed using a modified version of the Mehrabians Marital Satisfaction Scale. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate correlations, multivariate regression analyses, and mediation analyses. Postpartum PTSD symptoms were prospectively related to low couple relationship satisfaction at 2 years postpartum, even when controlling for a considerable number of background factors. When including postpartum depression symptoms as predictor in the analyses, the effect of postpartum PTSD was no longer significant. Moreover, more detailed analyses showed that postpartum depression symptoms acted as a significant mediator, fully explaining the association of postpartum PTSD with couples' relationship satisfaction. Early detection of couples' relationship problems and the provision of professional help, particularly in high-risk couples may not only improve the quality of the couple relationship but also improve parenting and promote positive child outcomes.
PDF
