Nearly 10% of women with cesarean delivery experience PTSD at 2 months postpartum

Key takeaways:

• PTSD symptoms occurred in 9% and a possible diagnosis occurred in 1.7% of women at 2 months after cesarean delivery.
• Women with immediate skin-to-skin contact with their newborn had lower PTSD risk.

At 2 months postpartum, about one in 11 women with cesarean deliveries at 34 weeks’ gestation or longer developed PTSD symptoms, according to study results published in the American Journal of Obstetrics and Gynecology.

“Although cesarean delivery alone may constitute a traumatic event, its experience may be influenced by maternal sociodemographic, medical, psychiatric and pregnancy-related characteristics as well as the content of the cesarean section,” Alizée Froeliger, MD, MPH, from the department of obstetrics and gynecology at Bordeaux University Hospital and Université Paris Cité Women’s Health IHM Perinatal Obstetrical and Pediatric Epidemiology Research Team at the Center for Research on Epidemiology and Statistics, Paris, and colleagues wrote. “Only a few studies have specifically assessed obstetric risk factors for PTSD among women with cesarean delivery, and their methodological limitations included their retrospective or insufficiently detailed collection of obstetric exposures and their lack of adjustment for other risk factors, especially psychiatric history.”

Froeliger and colleagues conducted a prospective ancillary cohort study with data from 4,431 women from the TRAAP2 trial, a double-blind, placebo-controlled randomized trial assessing the impact of tranexamic acid plus prophylactic oxytocin to prevent postpartum hemorrhage after cesarean delivery. All women underwent cesarean delivery before or during labor at 34 weeks’ gestation or longer at 27 French hospitals from 2018 to 2020. All women were instructed to complete the Impact of Event Scale–Revised (IES-R) and Traumatic of Event Scale (TES) questionnaires 2 months postpartum to assess the presence of PTSD symptoms and a positive screening for a diagnosis consisted with PTSD.

Overall, 62.9% of women completed the IES-R questionnaire and 63% of women completed the TES questionnaire. At 2 months postpartum, PTSD symptoms and a positive screening for a possible PTSD diagnosis were present among 9% and 1.7% of women, respectively.

The following characteristics were associated with a higher PTSD risk:

• younger age (adjusted OR = 0.8; 95% CI, 0.67-0.95);
• BMI of 30 kg/m² or higher (aOR = 1.55; 95% CI, 1.02-2.4);
• being born in North Africa (aOR = 3.55; 95% CI, 2.23-5.65) or sub-Saharan Africa (aOR = 2.02; 95% CI, 1.18-3.44);
• cesarean delivery after induced labor (aOR = 1.81; 95% CI, 1.14-2.87);
• postpartum hemorrhage (aOR = 1.61; 95% CI, 1.04-2.46);
• reporting high-intensity pain during postpartum hospitalization (aOR = 1.9; 95% CI, 1.17-3.11); and
• reporting bad memories of delivery 2 days postpartum (aOR = 3.2; 95% CI, 1.97-5.12).

Conversely, women with immediate skin-to-skin contact with their newborn had a lower PTSD risk (aOR = 0.66; 95% CI, 0.46-0.98), the researchers reported.

“Some obstetric interventions and components of management of cesarean deliveries may influence the risk of PTSD, including induction of labor, postpartum hemorrhage, absence of immediate skin-to-skin contact with the newborn and postoperative pain,” the researchers wrote. “This information should help perinatal caregivers improve primary prevention of this disorder and identify at-risk women who could benefit from early intervention.”