Symptoms of post-traumatic stress after preeclampsia

Abstract

This study describes the prevalence of postpartum post-traumatic stress disorder (PTSD) based on the DSM-IV criteria, including its symptoms of intrusion, avoidance and hyperarousal after pregnancies complicated by preeclampsia, and examines which variables are associated with PTSD and its symptoms. Women whose pregnancies were complicated by preeclampsia completed the Self-Rating Inventory for PTSD at 6 and 12 weeks postpartum: 149 women completed this questionnaire on at least one time point. Logistic regression analyses were used to examine associations with PTSD and its symptoms. Results showed that the prevalence of PTSD was 8.6% at 6 weeks, and 5.1% at 12 weeks postpartum; 21.9% of the study sample experienced postpartum symptoms of intrusion at 6 weeks postpartum (11.7% at 12 weeks), 9.4% symptoms of avoidance (8.0% at 12 weeks), and 28.9% symptoms of hyperarousal (20.4% at 12 weeks). Younger age, severe preeclampsia, cesarean section, lower gestational age, lower birth weight, admission to the neonatal intensive care unit, and perinatal death were found to be associated with PTSD and its symptoms. There was a relatively high prevalence of postpartum symptoms of PTSD among women after preeclampsia. The prevalence was highest among younger women who experienced more adverse pregnancy outcomes.

Keywords::

• HELLP syndrome
• post-traumatic stress syndrome
• postpartum
• preeclampsia

Acknowledgments

The authors thank all Pro-Active participants and the employees of the participating obstetric departments of the St. Elisabeth Hospital in Tilburg, the St. Franciscus Gasthuis in Rotterdam, and the Maasstad Hospital in Rotterdam, the Netherlands. We are grateful to research nurses Joke van Rhee and Wilma Keller-van der Es for their contribution to the data collection, and Gerard Borsboom for his assistance with the statistical analysis. This study was funded by the Netherlands Organization for Health Research and Development (ZonMw Grant # 6120.0024).

Declaration of interest: The authors report no declarations of interest.

Current knowledge on this subject

• PTSD is known to be associated with preeclampsia.

• The reported prevalence of PTSD after preeclampsia in retrospective and cross-sectional studies ranged from 11 to 44% in the late postpartum period.

• The only study examining variables that are associated with PTSD after preeclampsia, found that gestational age, peritraumatic distress, peritraumatic dissociation, negative interpretations of symptoms and suppression of condition-related thoughts were significantly associated with PTSD.

What this study adds

• In the early postpartum period, the prevalence of PTSD is relatively high among women after preeclampsia, as compared with a general sample of women after giving birth.

• This first prospective longitudinal cohort study has shown that the prevalence of PTSD after preeclampsia in the early postpartum period decreases from 6 weeks to 12 weeks postpartum.

• This is the first study to report on the prevalence of postpartum symptoms of intrusion, avoidance, and hyperarousal after preeclampsia.

• After preeclampsia, symptoms of PTSD are relatively more frequent among younger women (below 30 years of age), women who had severe preeclampsia, had a cesarean section, a low birth weight, a low gestational age at delivery, and among women whose child had been admitted to the neonatal intensive care unit or had died.

• After preeclampsia, younger women more often experienced adverse pregnancy outcomes, including severe preeclampsia, caesarean section, neonatal intensive care unit admission of their child, low gestational age at birth, low birth weight, and perinatal death.