Early prediction of childbirth-related posttraumatic stress disorder symptoms

Childbirth-related posttraumatic stress disorder (PTSD) is an underrecognized maternal morbidity. We tested whether obstetric complications increase risk for later PTSD symptoms through acute peritraumatic distress and early postpartum trauma symptoms. In a prospective cohort of 667 women, acute distress was assessed at 1.44 days postpartum, PTSD symptoms at approximately 10 days and 2 months postpartum, and depression symptoms at 10 days; obstetric complications were abstracted from medical records. Structural equation modeling showed that obstetric complications were associated with greater acute distress (β=0.292, p<0.001), which predicted higher PTSD symptoms at 10 days postpartum (β=0.561, p<0.001); early symptoms predicted symptoms at 2 months (β=0.665, p<0.001). The direct path from obstetric complications to 2-month PTSD symptoms was not significant. A significant serial indirect effect was observed through acute distress and early PTSD symptoms (β=0.109, p<0.001), whereas depression was not a mediator. These findings support early screening for childbirth-related PTSD risk after complicated delivery.