American journal of obstetrics and gynecology · 2026
Trajectories of childbirth-related posttraumatic stress symptoms after a vaginal delivery: a multicenter prospective study.
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Froeliger Alizée, Deneux-Tharaux Catherine, Loussert Lola, Sutter-Dallay Anne Laure, Madar Hugo, Sentilhes Loïc, Tranexamic Acid for Preventing Postpartum Hemorrhage Following a Vaginal Delivery (TRAAP) study group
Аннотация
BACKGROUND: Childbirth can be experienced as traumatic and lead to posttraumatic stress symptoms. The evolution of childbirth-related posttraumatic stress symptoms remains poorly documented.
OBJECTIVE: We aimed to characterize posttraumatic stress symptom trajectories after vaginal delivery and identify associated risk factors.
STUDY DESIGN: Ancillary cohort of the TRanexamic Acid for Preventing postpartum hemorrhage after vaginal delivery 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. Posttraumatic stress symptoms were assessed at day 2 and 2 months postpartum using the self-administered Impact of Event Scale-Revised questionnaire. Four trajectories were defined: asymptomatic (Impact of Event Scale-Revised <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 Impact of Event Scale-Revised 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 posttraumatic stress symptoms at day 2, persistent symptoms compared with recovery were associated with younger age (adjusted odds ratio, 0.8; 95% confidence interval, 0.6-0.9), non-European origin (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), psychiatric history (adjusted odds ratio, 1.9; 95% confidence interval, 1.2-2.4), bad memories of delivery (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.6), and hemoglobin <9 g/dL at day 2 (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.7). Among women without posttraumatic stress symptoms at day 2, emerging symptoms compared with asymptomatic trajectories were associated with previous abortion (adjusted odds ratio, 2.6; 95% confidence interval, 1.6-3.9), hospitalization during pregnancy (adjusted odds ratio, 2.8; 95% confidence interval, 1.4-4.7), labor induction (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.8), bad memories of delivery (adjusted odds ratio, 3.7; 95% confidence interval, 1.4-5.6), and fatigue at day 2 (adjusted odds ratio, 2.2; 95% confidence interval, 1.4-3.5), while epidural analgesia reduced the risk (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.7).
CONCLUSION: About 1 in 20 women present an unfavorable posttraumatic stress symptom 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 posttraumatic stress disorder screening strategies and highlight targets for preventive efforts.
OBJECTIVE: We aimed to characterize posttraumatic stress symptom trajectories after vaginal delivery and identify associated risk factors.
STUDY DESIGN: Ancillary cohort of the TRanexamic Acid for Preventing postpartum hemorrhage after vaginal delivery 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. Posttraumatic stress symptoms were assessed at day 2 and 2 months postpartum using the self-administered Impact of Event Scale-Revised questionnaire. Four trajectories were defined: asymptomatic (Impact of Event Scale-Revised <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 Impact of Event Scale-Revised 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 posttraumatic stress symptoms at day 2, persistent symptoms compared with recovery were associated with younger age (adjusted odds ratio, 0.8; 95% confidence interval, 0.6-0.9), non-European origin (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), psychiatric history (adjusted odds ratio, 1.9; 95% confidence interval, 1.2-2.4), bad memories of delivery (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.6), and hemoglobin <9 g/dL at day 2 (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.7). Among women without posttraumatic stress symptoms at day 2, emerging symptoms compared with asymptomatic trajectories were associated with previous abortion (adjusted odds ratio, 2.6; 95% confidence interval, 1.6-3.9), hospitalization during pregnancy (adjusted odds ratio, 2.8; 95% confidence interval, 1.4-4.7), labor induction (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.8), bad memories of delivery (adjusted odds ratio, 3.7; 95% confidence interval, 1.4-5.6), and fatigue at day 2 (adjusted odds ratio, 2.2; 95% confidence interval, 1.4-3.5), while epidural analgesia reduced the risk (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.7).
CONCLUSION: About 1 in 20 women present an unfavorable posttraumatic stress symptom 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 posttraumatic stress disorder screening strategies and highlight targets for preventive efforts.