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Bad memories of childbirth at 2 days postpartum may predict subsequent PTSD

19 Sep 2017
Post-traumatic stress disorder (PTSD) occurring within a year after childbirth via vaginal delivery is not rare, being strongly associated with bad memories of delivery at day 2 postpartum, a study has found.

The study included 1,103 women whose delivery and postpartum data were prospectively collected via questionnaires, including an item assessing experience of delivery at day 2, mailed 1 year after childbirth. PTSD diagnosis and profile at year 1 after a vaginal delivery was the primary study outcome. Objective measures of psychological symptoms during the said time were also evaluated.

Of the women, 22 (4.2 percent) met the PTSD diagnostic criteria while 30 (5.7 percent) met the PTSD profile criteria. Multivariable logistic regression analysis showed that factors including previous abortion (adjusted odds ratio [aOR], 3.6; 95 percent CI, 1.4 to 9.3), previous postpartum haemorrhage (aOR, 5.3; 1.3 to 21.4) and postpartum haemoglobin <9 g/dl (aOR, 2.7; 1.0 to 7.5) were associated with increased risk of PTSD profile.

Notably, the proportions of women who met PTSD diagnosis and profile criteria a year later were greater in the group of respondents who reported bad childbirth memories at day 2 postpartum (n=56) than in the group of those with good memories (n=498; PTSD diagnosis, 21.1 vs 2.4 percent; PTSD profile, 21.1 vs 3.8 percent; p<0.001 for both).

Findings of the present study suggest that PTSD is not rare at 1 year after vaginal delivery in a low-risk population, researchers said. The data also highlight the potential utility of asking the question “Today, what are your memories of your childbirth?” at day 2 postpartum in identifying women most at risk of PTSD and determining if early intervention is needed.

Furthermore, the observed association between increased PTSD profile risk and haemoglobin level <9 g/dl at day 2 postpartum is consistent with previously reported associations between postpartum anaemia and mood and depressive disorders, and between haemoglobin level and depressive symptoms. [Am J Obstet Gynecol 2005;193:36–44; J Nutr 2003;133:4139–42]

“Our results strongly support the need for healthcare providers to try to prevent iron deficiency during the postpartum period, as recommended by several expert groups,” researchers said.

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