Associations between PTSD and pregnancy outcomes: systematic review and Meta- analysis

Post-Traumatic Stress Disorder (PTSD) is a prevalent and debilitating mental health condition. PTSD may be an important underlying mechanism in pregnancy and obstetric complications as well as adverse neonatal outcomes.

The primary objective of this systematic review and meta-analysis is to evaluate associations between maternal PTSD and pregnancy, obstetric and neonatal outcomes.

A comprehensive literature search was conducted using Google Scholar, PubMed, and EMBASE databases. The search included recent data from various sources: databases, indexes, registries, abstracts, proceedings, references, experts, and institutions. Terms like PTSD, perinatal, pregnancy, and neonatal outcomes were used, the search was limited to English and human studies.

The inclusion criteria for detailed review focused on studies relevant to the topic, involving populations with perinatal PTSD, and assessing pregnancy, obstetric and neonatal outcomes. Two reviewers independently assessed the studies for eligibility, resolving discrepancies through discussion and consensus. Out of 369 initially identified studies, 40 met the selection criteria and were included in the review.

We followed PRISMA guidelines for data abstraction. Independent observers extracted data. Meta-analysis was conducted using a random-effects model, and evidence was evaluated according to GRADE guidelines. Statistical analysis was performed using R version 3.6.2.

40 studies were reviewed, including 27 prospective cohort, five retrospective cohort, four cross-sectional, and four case-control studies, totaling 157,708 pregnancies. Among them, 11,750 showed PTSD symptoms. Maternal PTSD was associated with smaller infant head circumference, sleeping/eating issues, reduced breastfeeding, and lower infant cortisol levels. Research varies on PTSD's connection to low birthweight (LBW) and preterm birth (PTB). Meta-analyses of available data indicated significant associations: PTSD increased LBW risk (pooled OR 2.05; 95%CI: [1.27, 3.33]) and PTB risk (pooled OR 1.23; 95%CI: [1.11, 1.37]). GRADE analysis found overall low-quality evidence for LBW and PTB.

PTSD in pregnancy links to adverse outcomes in both pregnancy and neonates. Preventing PTSD and addressing its causes during this period is vital for maternal, obstetric, and neonatal health. Further research, especially on pregnancy treatment effects, is necessary for informed clinical practices and policies.