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Journal Article Ahead of print 2 citations

PubMed: 42361947 DOI: 10.1016/j.ajog.2026.06.020

Trajectories of childbirth-related posttraumatic stress symptoms after a vaginal delivery: a multicenter prospective study.

Am J Obstet Gynecol

Authors: Alizée Froeliger, Catherine Deneux-Tharaux, Lola Loussert, Anne Laure Sutter-Dallay, Hugo Madar, Loïc Sentilhes

Affiliations

  • Université Paris Cité, Université Paris Nord, INSERM, INRAE, Center for Research on Epidemiology and StatisticS, Obstetrical Perinatal and Pediatric Life course Epidemiology OPPaLE, Paris, France; Department of Obstetrics and Gynecology, Bordeaux University Hospital, France; Institute for Women and Interdisciplinary Research in Science and Health iWISH, Université Paris Cité, Paris, France.
  • Université Paris Cité, Université Paris Nord, INSERM, INRAE, Center for Research on Epidemiology and StatisticS, Obstetrical Perinatal and Pediatric Life course Epidemiology OPPaLE, Paris, France; Institute for Women and Interdisciplinary Research in Science and Health iWISH, Université Paris Cité, Paris, France.
  • Université Paris Cité, Université Paris Nord, INSERM, INRAE, Center for Research on Epidemiology and StatisticS, Obstetrical Perinatal and Pediatric Life course Epidemiology OPPaLE, Paris, France; Institute for Women and Interdisciplinary Research in Science and Health iWISH, Université Paris Cité, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, France.
  • Department of Perinatal Psychiatry, Charles Perrens Hospital, Bordeaux University Hospital, France; BPH Research Center, INSERM 1219, HEALTHY Team, Bordeaux University, Bordeaux, France.
  • Université Paris Cité, Université Paris Nord, INSERM, INRAE, Center for Research on Epidemiology and StatisticS, Obstetrical Perinatal and Pediatric Life course Epidemiology OPPaLE, Paris, France; Department of Obstetrics and Gynecology, Bordeaux University Hospital, France; Institute for Women and Interdisciplinary Research in Science and Health iWISH, Université Paris Cité, Paris, France.
  • Department of Obstetrics and Gynecology, Bordeaux University Hospital, France.

Abstract

BACKGROUND

Childbirth can be experienced as traumatic and lead to posttraumatic stress symptoms (PSS). The evolution of childbirth-related PSS remains poorly documented.

OBJECTIVES

We aimed to characterize PSS trajectories after vaginal delivery and identify associated risk factors.

STUDY DESIGN

Ancillary cohort of the TRanexamic Acid for Preventing postpartum hemorrhage after vaginal delivery (TRAAP) trial in 15 French university hospitals (2015-2016) including women delivering vaginally after 35 weeks' gestation. After randomization, characteristics of the labor and delivery were prospectively collected. PSS were assessed at day 2 and 2 months postpartum using the self-administered Impact of Event Scale-Revised (IES-R) questionnaire. Four trajectories were defined: asymptomatic (IES-R <22 at both time points), recovered (≥22 at day 2; <22 at 2 months), emerging (<22 at day 2; ≥22 at 2 months), and persistent (≥22 at both). Prevalences were corrected for nonresponse using inverse probability weighting. Risk factors were assessed using multivariable logistic regression.

RESULTS

Among 3891 women, 2344 (60.2%) completed the IES-R at both assessments. Corrected prevalences were 83.4% (81.8-85.0) asymptomatic, 11.0% (9.7-12.4) recovered, 2.1% (1.6-2.8) emerging, and 3.5% (2.7-4.4) persistent. Among women with PSS at day 2, persistent symptoms compared with recovery were associated with younger age (aOR 0.8; 95%CI 0.6-0.9), non-European origin (aOR 1.8; 95%CI 1.2-2.6), psychiatric history (aOR 1.9; 95%CI 1.2-2.4), bad memories of delivery (aOR 2.4; 95%CI 1.3-4.6), and hemoglobin <9 g/dL at day 2 (aOR 1.8; 95%CI 1.1-2.7). Among women without PSS at day 2, emerging symptoms compared with asymptomatic trajectories were associated with previous abortion (aOR 2.6; 95%CI 1.6-3.9), hospitalization during pregnancy (aOR 2.8; 95%CI 1.4-4.7), labor induction (aOR 1.7; 95%CI 1.1-2.8), bad memories of delivery (aOR 3.7; 95%CI 1.4-5.6), and fatigue at day 2 (aOR 2.2; 95%CI 1.4-3.5), while epidural analgesia reduced the risk (aOR 0.2; 95%CI 0.1-0.7).

CONCLUSION

About 1 in 20 women present an unfavorable PSS trajectory up to 2 months after a term vaginal delivery. The risk factors for a persistent trajectory were notably preexisting vulnerabilities, bad memories of delivery and postpartum anemia at day 2 postpartum, whereas emerging trajectories were more closely associated with obstetric risk factors. These findings may help inform potential postpartum PTSD screening strategies and highlight targets for preventive efforts.

MeSH

Labor, Induced, Pregnancy, Mental Disorders, Stress, Physiological, Obstetrics, Analgesia, Epidural, Signs And Symptoms, Gynecology, Risk Factors, Postpartum Period, Prospective Studies