Early prediction of childbirth-related posttraumatic stress disorder symptoms

Medically complicated childbirth is associated with increased risk of childbirth-related posttraumatic stress disorder (PTSD), yet mechanisms linking complications to persistent PTSD symptoms remain poorly understood.

A total of 667 women were followed from pregnancy through 6 months postpartum in a prospective longitudinal study. Acute childbirth-related distress was assessed during the immediate postpartum hospitalization using the Peritraumatic Distress Inventory. Childbirth-related PTSD symptoms were assessed at approximately 10 days, 2 months, and 6 months postpartum using the PTSD Checklist for DSM-5. Obstetric information was extracted from electronic medical records. Structural equation modeling examined pathways linking medically complicated childbirth, acute distress, early postpartum PTSD symptoms, postpartum depression, and subsequent PTSD symptoms.

Medically complicated childbirth was related to later childbirth-related PTSD symptoms through sequential pathways. Complications predicted greater acute distress (β = 0.292, p < 0.001), which was strongly associated with PTSD symptoms at approximately 10 days postpartum (β = 0.561, p < 0.001). The serial indirect pathway to 2-month PTSD through acute distress and early PTSD symptoms was significant (B = 1.96, 95% CI [1.15, 2.98], p < 0.001). This pathway extended to 6 months through acute distress, early PTSD symptoms, and 2-month PTSD symptoms (B = 0.82, 95% CI [0.35, 1.48], p = 0.005). Direct effects of obstetric complications were nonsignificant, and postpartum depression did not mediate these associations.

Medically complicated childbirth may contribute to persistent childbirth-related PTSD through heightened acute distress and the subsequent progression of trauma-related symptoms, highlighting the immediate and early postpartum periods as important windows for risk identification.