Risk factors for PTSD after birth in a normal population: A meta-analysis

Evidence suggests that a proportion of women report posttraumatic stress disorder (PTSD) after childbirth, with between 1 and 3% of women developing the disorder as a direct result of birth (Alcorn, O'Donovan, Patrick, Creedy, & Devilly). A range of factors are associated with postpartum PTSD, including prepartum, birth and postpartum factors. This meta-analysis synthesizes research on posttraumatic stress symptoms after childbirth in order to identify key vulnerability and risk factors. Method: A systematic search was carried out on databases (PsychInfo, PubMed, Scopus and Web of Science) using PTSD terms (posttraumatic stress, post-traumatic stress, trauma*, PTSD) crossed with childbirth-related terms (birth, pregnancy, partum, postpartum, prenatal, postnatal, stillbirth, miscarriage, gestation, partus, labour). Studies were included if they reported primary research examining factors associated with birth-related PTSD symptoms. PTSD had to be measured at least one month after birth to avoid confusion with acute stress disorder symptoms. Research on specific populations was excluded e.g. teenagers, pregnancy loss or stillbirth. Results: Of the 792 records screened, 48 papers reporting results of 43 research studies fulfilled inclusion criteria (N=20,372). Key vulnerability and risk factors were subjective birth experience, particularly negative emotions during birth, a fear of childbirth, and a history of PTSD or depression. Postpartum PTSD was highly comorbid with concurrent symptoms of depression. Conclusion: Identification of vulnerability and risk factors for postpartum PTSD is critical for appropriate screening and prevention. Future research needs to examine the interaction between vulnerability and risk factors, as proposed by theoretical frameworks of postpartum PTSD (Ayers 2004; Slade 2006)