Table 7.
Association and effect size of maternal morbidity and other variables on PTSD (profile/symptoms)
| Study | N | Method | Results (in case of ORs: risk vs. reference) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Adewuya et al., 2006 |
876 |
Stepwise multiple regressions |
M.I.N.I |
PTSD |
6 wks |
Admission due to pregnancy complication: yes vs. no |
Adjusted OR: 11.9 † |
(95%CI: 6.4–22.1) |
|
| |
|
|
|
|
|
Mode of delivery |
|||
| |
|
|
|
|
|
- Instrumental vs. spontaneous vaginal |
Adjusted OR: 7.9 † |
(95%CI: 3.9–16.2) |
|
| |
|
|
|
|
|
- EmCS vs. spontaneous vaginal |
Adjusted OR: 7.3 † |
(95%CI:3.5–15.2) |
|
| |
|
|
|
|
|
- ElCS vs. spontaneous vaginal |
Adjusted OR: 2.0 |
(95%CI: 0.4–8.9) |
|
| |
|
|
|
|
|
Mode of placental removal: manual vs. normal |
Adjusted OR: 5.0 † |
(95%CI: 2.4–10.1) |
|
| |
|
|
|
|
|
Perceived control in childbirth: LAS < 40 vs. > 40 |
Adjusted OR: 5.1 † |
(95%CI: 2.7–9.5) |
|
| Ayers, 1999 |
220 |
Mann Whitney Spearman's correlation |
IES |
Intrusions (sub-sum score) |
6 wks |
Delivery complication: presence vs. absence |
ns |
||
| |
|
|
|
|
|
Amount of blood loss |
ns |
||
| |
|
Kruskal-Wallis |
|
|
|
Type of delivery (eg. EmCS) |
ns |
||
| |
|
Partial correlation (removing an effect of PTSD symptoms in pregnancy) |
|
|
|
Appraising birth as traumatic |
Partial correlation β=.20 ** (one tailed) |
||
| |
|
|
|
|
|
Different from how women wanted to be |
Partial correlation β=.17* |
||
| |
201 |
|
|
|
6 mths |
Delivery complication: presence vs. absence |
ns |
||
| |
|
|
|
|
|
Amount of blood loss |
ns |
||
| |
|
|
|
|
|
Type of delivery (eg. EmCS) |
ns |
||
| |
|
|
|
|
|
Appraising birth as traumatic |
Partial correlation β=.19 ** (one tailed) |
||
| |
|
|
|
|
|
Different from how women wanted to be |
Partial correlation β=.22** |
||
| |
220 |
|
|
Avoidance (sub-sum score) |
6 wks |
Delivery complication: presence vs. absence |
ns |
||
| |
|
|
|
|
|
Amount of blood loss |
ns |
||
| |
|
|
|
|
|
Type of delivery (eg. EmCS) |
ns |
||
| |
|
|
|
|
|
Appraising birth as traumatic |
Partial correlation β=.23 ** (one tailed) |
||
| |
|
|
|
|
|
Different from how women wanted to be |
Partial correlation β=.35*** |
||
| |
|
|
|
|
|
|
|||
| |
201 |
|
|
|
6 mths |
Delivery complication: presence vs. absence |
Unadjusted U=2553 * |
||
| |
|
|
|
|
|
Amount of blood loss |
ns |
||
| |
|
|
|
|
|
Type of delivery (eg. EmCS) |
ns |
||
| |
|
|
|
|
|
Appraising birth as traumatic |
Partial correlation β=.24 *** (one tailed) |
||
| |
|
|
|
|
|
Different from how women wanted to be |
Partial correlation β=.29 *** |
||
| Baecke et.al, 2009 |
169 |
Method for ORs: not stated |
IES |
PTSD symptoms |
6-18 mths |
Preterm preeclampsia vs. Term, uneventful |
(Adjusted?) OR: 6.2† |
(95%CI: 2.5-15.8) |
|
| |
|
|
|
|
|
Preterm preeclampsia vs. Term preeclampsia |
(Adjusted?) OR: 6.2† |
(95%CI: 1.3-30.1) |
|
| |
|
|
|
|
|
Preterm, no complication vs. Term, uneventful |
(Adjusted?) OR: 5.5† |
(95%CI: 2.0-15.2) |
|
| Cohen et al., 2004 |
184 |
Multivariable logistic regression |
DTS |
Postpartum stress (high/low) |
8-10 wks |
Maternal complications: 2+ vs. 0-1 |
Adjusted OR: 4.0† |
(95%CI: 1.3-12.8) |
|
| |
|
|
|
|
|
Depression during pregnancy: yes vs. no |
Adjusted OR: 18.9† |
(95%CI: 5.8-62.4) |
|
| |
|
|
|
|
|
History of traumatic events: 2+ vs. 0–1 |
Adjusted OR: 3.2† |
(95%CI: 1.2-8.3) |
|
| |
|
|
|
|
|
Born in Canada vs. Not born in Canada |
Adjusted OR: 3.2† |
(95%CI: 1.3-8.1) |
|
| |
|
|
|
|
|
Income (Canadian $) |
|
|
|
| |
|
|
|
|
|
- lowest (<$32,000) vs. high (>$8000) |
Adjusted OR: 0.1† |
(95%CI: 0.02-0.5) |
|
| |
|
|
|
|
|
- middle ($32,000-80,000) vs. high (>$8000) |
Adjusted OR: 0.4† |
(95%CI: 0.2-0.8) |
|
| Creedy et al., 1999 |
499 |
Simple regression |
IES |
PTSD symptom severity (sum score) |
4-6 wks |
Preparedness for labour and delivery |
ns |
||
| |
|
Stepwise multiple regressions |
|
|
|
Maternal complications |
ns |
||
| |
|
|
|
|
EmCS |
Adjusted β=.20*** |
|||
| |
|
|
|
|
|
Forceps delivery |
Adjusted β=.17*** |
||
| |
|
|
|
|
|
Vacuum delivery |
Adjusted β=.14** |
||
| |
|
|
|
|
|
Post-delivery pain |
Adjusted β=.16*** |
||
| |
|
|
|
|
|
Neonatal complications |
Adjusted β=.10* |
||
| |
|
Hierarchical multiple regression |
|
|
|
Final model (Accounted for 21% of variance) |
|
||
| |
|
|
|
|
|
Perception of maternity care (step 1) |
Adjusted β=.-32*** |
||
| |
|
|
|
|
|
Obstetric intervention (step 2) |
Adjusted β=.26*** |
||
| |
|
|
|
|
|
|
|||
| |
141 |
Multiple regression |
|
|
3 mths |
Final model (Accounted for 24% variance) |
|
||
| |
|
|
|
|
|
Preparedness for labour and delivery |
Adjusted β=.-16* |
||
| |
|
|
|
|
|
Obstetric intervention |
Adjusted β=.15* |
||
| |
|
|
|
|
|
Perception of maternity care |
Adjusted β=.42*** |
||
| Engelhard et.al, 2002 |
113 |
Hierarchical multiple regression |
PSS-SR |
PTSD symptom severity |
Within 2 yrs |
Final mode (Accounted for 61% of the variance) |
|
||
| |
|
|
|
|
|
Gestational age at admission (step 1) |
ns |
||
| |
|
|
|
|
|
Peritraumatic distress (step 2) |
ns |
||
| |
|
|
|
|
|
Peritraumatic dissociation (step 2) |
Adjusted β=.27** |
||
| |
|
|
|
|
|
Negative interpretations (step 3) |
Adjusted β=−.40* |
||
| |
|
|
|
|
|
Thought suppression (step 3) |
Adjusted β=−.25* |
||
| Hoedjes et al., 2011 |
149 |
Logistic regression for each variable (adjusting only for assessment time – 6 and 12 weeks postpartum using GEE‡) |
SRIP |
PTSD profile (yes/no) |
6-12 wks |
Severity of preeclampsia: severe vs. mild |
Unadjusted OR: 5.0* |
(95%CI: 0.6–38.8) |
|
| |
|
|
|
|
|
Mode of delivery: CS vs. vaginal |
Unadjusted OR: 8.4* |
(95%CI: 1.1–65.5) |
|
| |
|
|
|
|
|
Age |
Unadjusted OR: 0.6* |
(95%CI: 0.4–0.7) |
|
| |
|
|
|
|
|
Gestational age at delivery |
Unadjusted OR: 0.8* |
(95%CI: 0.7–1.0) |
|
| |
|
|
|
Intrusions (yes/no) |
|
Severity of preeclampsia: severe vs. mild |
Unadjusted OR: 5.5* |
(95%CI: 1.6–18.7) |
|
| |
|
|
|
|
|
Mode of delivery: CS vs. vaginal |
Unadjusted OR: 4.3* |
(95%CI: 1.7–10.6) |
|
| |
|
|
|
|
|
Admission to NICU: yes vs. no |
Unadjusted OR: 5.9* |
(95%CI: 2.4–15.0) |
|
| |
|
|
|
|
|
Perinatal death: yes vs. no |
Unadjusted OR: 7.1* |
(95%CI: 1.8–27.8) |
|
| |
|
|
|
|
|
Age |
Unadjusted OR: 0.8* |
(95%CI: 0.7–0.9) |
|
| |
|
|
|
|
|
Gestational age at delivery |
Unadjusted OR: 0.9* |
(95%CI: 0.8–0.9) |
|
| |
|
|
|
|
|
Birth weight |
Unadjusted OR: 0.5* |
(95%CI: 0.3–0.8) |
|
| |
|
|
|
Avoidance (yes/no) |
|
Mode of delivery: CS vs. vaginal |
Unadjusted OR: 3.9* |
(95%CI: 1.1–13.9) |
|
| |
|
|
|
|
|
Admission to NICU: yes vs. no |
Unadjusted OR: 4.3* |
(95%CI: 1.2–15.6) |
|
| |
|
|
|
|
|
Age |
Unadjusted OR: 0.7* |
(95%CI: 0.6–0.8) |
|
| |
|
|
|
|
|
Gestational age at delivery |
Unadjusted OR: 0.9* |
(95%CI: 0.8–0.9) |
|
| |
|
|
|
|
|
Birth weight |
Unadjusted OR: 0.4* |
(95%CI: 0.2–1.0) |
|
| |
|
|
|
|
|
|
|||
| |
|
|
|
Hyperarousal (yes/no) |
|
Severity of preeclampsia: severe vs. mild |
Unadjusted OR: 3.0* |
(95%CI: 1.2–7.9) |
|
| |
|
|
|
|
|
Mode of delivery: CS vs. vaginal |
Unadjusted OR: 2.6* |
(95%CI: 1.2–5.7) |
|
| |
|
|
|
|
|
Admission to NICU: yes vs. no |
Unadjusted OR: 2.8* |
(95%CI: 1.3–5.8) |
|
| |
|
|
|
|
|
Perinatal death: yes vs. no |
Unadjusted OR: 6.6* |
(95%CI: 1.1–39.6) |
|
| |
|
|
|
|
|
Age |
Unadjusted OR: 0.9* |
(95%CI: 0.8–1.0) |
|
| |
|
|
|
|
|
Gestational age at delivery |
Unadjusted OR: 0.9* |
(95%CI: 0.8–1.0) |
|
| |
|
|
|
|
|
Birth weight |
Unadjusted OR: 0.6* |
(95%CI: 0.4–0.8) |
|
| Lev-Wiesel et al, 2009 |
1071 |
Linear multiple regression |
PSS-I |
PTSD symptoms severity |
6 mths |
Final model (Accounted for 41% of the variance) |
|
|
|
| |
|
|
|
(sum score) |
|
Subjective pain and distress during delivery |
Adjusted β=.51*** |
||
| |
|
|
|
|
|
PTS during pregnancy |
Adjusted β=.04 |
||
| |
|
|
|
|
|
Delivery complications |
Adjusted β=.04 |
||
| |
|
|
|
|
|
Depression during pregnancy |
Adjusted β=.15*** |
||
| |
|
|
|
|
|
History of traumatic events |
Adjusted β=.08** |
||
| |
|
|
|
|
|
High risk pregnancy |
Adjusted β=.03 |
||
| Sorenson & Tschetter, 2010 |
71 |
Point-biserial correlation coefficient |
PTCS |
Posttraumatic childbirth stress (low/high) |
6–7 mths |
Maternal complications: yes vs. no |
Unadjusted rpbs = 0.28 † |
||
| |
|
|
|
|
|
Infant complications: yes vs. no |
Unadjusted rpbs = 0.25 † |
||
| Stramrood et al, 2010 |
175 |
Hierarchical multiple regression |
PSS-SR |
PTSD symptoms severity |
6 wks |
Final model (Accounted for 39% of the variance) |
|
||
| |
|
|
|
|
|
A history of depression (step 1) |
Adjusted β=.23** |
||
| |
|
|
|
|
|
BDI scores during pregnancy (step 1) |
Adjusted β=.33*** |
||
| |
|
|
|
|
|
Death of infant (step 2) |
Adjusted β=.29*** |
||
| |
|
|
|
|
|
Hospital admission of the infant (step 2) |
ns |
||
| |
|
|
|
|
|
Birth weight (step 2) |
ns |
||
| |
|
|
|
|
|
Diagnosis of the mother (PE vs PPROM) (step 2) |
ns |
||
| |
|
|
|
|
|
CS (step 2) |
ns |
||
| |
|
|
|
|
|
|
|||
| Stramrood et al, 2011 |
428 |
Hierarchical multiple regression |
TES-B |
PTSD symptoms severity (sum score) |
2 to 6 mths |
Final model (Accounted for 41% of the variance) |
|
||
| |
|
|
|
|
|
Country of origin (step 1) |
Adjusted β=.004 |
||
| |
|
|
|
|
|
Primiparity (step 1) |
Adjusted β=.06 |
||
| |
|
|
|
|
|
Preeclampsia/HELLP syndrome (step 1) |
Adjusted β=.08 |
||
| |
|
|
|
|
|
Hypertension (step 1) |
Adjusted β=.04 |
||
| |
|
|
|
|
|
Preterm delivery (step 1) |
Adjusted β=.04 |
||
| |
|
|
|
|
|
Secondary/tertiary care (step 2) |
Adjusted β=−.09 |
||
| |
|
|
|
|
|
Hospital delivery (step 2) |
Adjusted β=−.05 |
||
| |
|
|
|
|
|
Induction of labour (step 2) |
Adjusted β=−.02 |
||
| |
|
|
|
|
|
Instrumental vaginal delivery (step 2) |
Adjusted β=−.08 |
||
| |
|
|
|
|
|
Unplanned caesarean section (step 2) |
Adjusted β=.11** |
||
| |
|
|
|
|
|
Postpartum haemorrhage (>1L) (step 2) |
Adjusted β=.06 |
||
| |
|
|
|
|
|
Manual placenta removal (step 2) |
Adjusted β=.04 |
||
| |
|
|
|
|
|
Perinatal death (step 2) |
Adjusted β=.06 |
||
| |
|
|
|
|
|
N(I)CU admittance (infant) (step 2) |
Adjusted β=.05 |
||
| |
|
|
|
|
|
ICU admittance (mother) (step 2) |
Adjusted β=.03 |
||
| |
|
|
|
|
|
Fear of childbirth (high) (step 3) |
Adjusted β=.02 |
||
| |
|
|
|
|
|
Delivery worse than expected (step 3) |
Adjusted β=.01 |
||
| |
|
|
|
|
|
Intensity of pain (high) (step 3) |
Adjusted β=.11* |
||
| Sense of Coherence (low) (step 3) | Adjusted β=.53*** | ||||||||
Note *p<0.05. **p<0.01, ***p<0.001, ns: none significance, † significance but the level of significance was not reported.
‡ GEE: generalized estimating equation.