Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women

Global burden of female infertility attributable to sexually transmitted infections and maternal sepsis: 1990-2021 and projections to 2050

Infectious diseases, such as sexually transmitted infections (STIs) and maternal sepsis, are major contributors to female infertility, creating a substantial burden on women of reproductive age. Based on Global Burden of Disease (GBD) 2021, this study analyzed the global trends and regional disparities in infection-related infertility for women aged 15-49 and projected future burdens. Our result showed that from 1990 to 2021, global age-standardized prevalence rate (ASPR) rose from 839.52 to 982.37 per 100,000 with estimated annual percentage change (EAPC) (0.26 [0.19 to 0.33]), and years lived with disability (YLDs) increasing from 62.81 to 106.69 thousand (EAPC 0.23 [0.16 to 0.31]), and was predicted to continue rising from 2022 to 2050. The disease burden showed significant regional disparities, low socio-demographic index (SDI) regions had the highest ASPR (1247.25 per 100,000 [1085.17 to 1443.57]) but also the fastest decline (EAPC -1.17 [-1.34 to -0.99]), and Western Sub-Saharan Africa (ASPR 1,925.52 [1655.35 to 2241.71] per 100,000) are the regions with highest burden. The disease burden increased with age, peaking at 40-44 years, and was inversely associated with SDI. These findings provide essential insights for policymakers to develop targeted strategies to prevent and control infection-related infertility, particularly in low-SDI regions.

The time of motherhood in a time of crisis: a longitudinal qualitative study

AIMS/BACKGROUND

The impact of the COVID-19 pandemic on the health of women in the perinatal period has been widely shown in literature. Although longitudinal quantitative studies investigated the long-term effects of the COVID-19 pandemic on both women and children's health, no longitudinal qualitative study can be found within literature. The study aimed at an in-depth exploration of the longitudinal trajectories, from pregnancy to postpartum, lived by women through the waves of the COVID-19 pandemic in Italy.

DESIGN/METHODS

As a method, the qualitative approach of Longitudinal Interpretative Phenomenological Analysis was used. A total of 14 women were interviewed for the first time during pregnancy (March-May 2021/second wave of the COVID-19 spread). Among the total, 8 completed a second interview, one year later, during postpartum (March-May 2022/end of the COVID-19 public emergency) and were included in the analysis.

RESULTS

Three superordinated themes emerged: (1) Maternal functions during the COVID-19 pandemic; (2) 'Care' needs of women in maternal services; (3) Unspeakable: obstetric violence and gender inequality in the working field. Themes were organised considering women's experience, showing continuity and discontinuity paths overtime.

CONCLUSION

Women in their perinatal period during the COVID-19 pandemic felt like 'living incubators', both isolated and invested in individual and social responsibilities of 'caring'.The study confirms the need to re-centre maternal care services' praxis on women's needs as an act of collective repair against the consequences of collective trauma of the COVID-19 pandemic.

A nomogram for predicting postpartum post-traumatic stress disorder: a prospective cohort study

BACKGROUND

Postpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.

METHODS

Recruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.

RESULTS

A total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.

CONCLUSIONS

With its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England

BACKGROUND

Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS.

METHODS

Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS.

FINDINGS

Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk.

INTERPRETATION

Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.

Changes to women's childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study

A considerable number of women giving birth during COVID-19 pandemic reported being concerned about changes to their childbirth plans and experiences due to imposed restrictions. Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans. Therefore, this study aimed to examine if the mismatch between women's planned birth and actual birth experiences during COVID-19 was associated with women's postpartum PTSS. Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors, and PTSS (PTSD checklist DSM-5 version) using self-report questionnaires (ClinicalTrials.gov: NCT04595123). More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans. All changes were significantly associated with PTSS scores. Participants with one and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes (Exp(β) = 1.12; 95% CI [1.06-1.19]; p < 0.001 and Exp(β) = 1.38; 95% CI [1.29-1.48]; p < 0.001). In addition, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida (Exp(β) = 0.86; 95% CI [0.77-0.97]; p = 0.014). Changes to women's childbirth plans during the COVID-19 pandemic were common and associated with women's postpartum PTSS score. Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.

Post-Traumatic Stress Disorder in Brazilian Pregnant Women at the Beginning of the Coronavirus Disease Pandemic

OBJECTIVE

Analyze the presence of PTSD symptoms and their risk among the pregnant women during the COVID-19 pandemic.

METHODS

This is a cross-sectional study of pregnant women that received receiving prenatal care at two university hospitals in São Paulo, Brazil, during the COVID-19 pandemic, from April to June 2020. The sociodemographic and health data of the participants and their exposure to individuals suspected or confirmed to have COVID-19 were evaluated. The Impact of Event Scale-Revised and the State-Trait Anxiety Inventory were used to assess PTSD and anxiety symptoms, respectively.

RESULTS

A total of 149 pregnant women were included in this study. The risk of PTSD among the participants was 55.1%. The independent risk factors for PTSD were state anxiety (ORadj = 2.6), trait anxiety (ORadj = 10.7), changes in routine due to the pandemic (ORadj = 4.7) and contact with a confirmed case of COVID-19 person (ORadj = 7.1).

CONCLUSIONS

The COVID-19 pandemic had a significant negative impact on the mental health of pregnant women, more than half of the participants of the present study showed a risk of PTSD, exacerbated by anxiety symptoms and exposure to individuals with a confirmed case of COVID-19.

Impact of trauma, support, and control perceptions during childbirth on post-traumatic stress disorder among Syrian immigrant adolescent pregnant women

OBJECTIVE

The probability of experiencing mental health problems in the perinatal period is high for adolescent women. Immigration is a complicated phenomenon that increases the risk of encountering temporary or permanent psychological problems. This study aims to determine Syrian immigrant adolescent women's support and control perception levels during childbirth, birth trauma levels, and posttraumatic stress disorder incidence and affecting factors.

METHODS

This study used a prospective cohort design and was conducted in a hospital in Adana, a city in southern Turkey, between February and April 2022. It included 122 Syrian adolescent immigrant women, and data were collected in two interviews. While the first interview was conducted within the first 24 hours following birth, the second interview was conducted one month after birth. Data were collected through structured interviews using standardized questionnaires, including the Personal Information Form, the City Birth Trauma Scale, the Support and Control in Birth Scale, and the Post-traumatic Stress Disorder Checklist for DSM-5.

FINDINGS

The average age of participating women was 17.40±0.94. The participants' Perceived Support and Control in Birth Scale total score was 100.55±20.12, the City Birth Trauma Scale total score was 43.11±13.29, and the Post-traumatic Stress Disorder Checklist total score was 30.36±16.86. Of all the participating women, 26% were found to have post-traumatic stress disorder symptoms in the postpartum period. A relationship was found between support and control perceptions during childbirth and post-traumatic stress disorder symptoms.

CONCLUSION

This study found that immigrant adolescent women's support and control perceptions during childbirth were better than expected, and they had a high level of perceived trauma during childbirth. The presence of birth trauma emerged as a robust predictive factor for posttraumatic stress disorder, underscoring its critical role in maternal mental health. A positive childbirth experience, which is important for all women, has become an increasing need for immigrant women. There is a need for developing and sustaining health policies guaranteeing culturally sensitive care to prevent immigrant women from having a traumatic birth experience.