Careful considerations for the treatment of posttraumatic stress disorder during and following pregnancy

ABSTRACT

Introduction

The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature was undertaken and coupled with expert clinical insights to discuss current clinical practice recommendations for PTSD in the perinatal period.

Areas covered

This review covers considerations for the assessment, prevention, and treatment of PTSD during the perinatal period. Within these sections, evidence-based and promising practices are outlined. Extra attention is afforded to treatment, which includes considerations from both psychotherapeutic and psychopharmacological perspectives. This review closes with coverage of three important and related areas of consideration, including bereavement, intimate partner violence, and childhood sexual abuse.

Expert opinion

Psychotherapeutic interventions for PTSD during pregnancy are limited, and no strong recommendations can be supported at this time while evidence points toward the effectiveness of cognitive behavioral therapies and eye movement desensitization therapy as first-line treatments postpartum though research evidence is also limited. Research on psychopharmacological interventions is similarly scarce, though selective serotonin reuptake inhibitors may be beneficial. Clinicians should also be mindful of additional considerations that may be needed for the treatment of PTSD in the context of bereavement, intimate partner violence, and history of sexual violence.

KEYWORDS:

• Perinatal
• post-traumatic stress disorder
• treatment
• pregnancy
• postpartum
• maternal

Article highlights

• Prevention of PTSD during the perinatal period is critical and can be supported through the careful consideration of vulnerability factors and the reduction of negative birth experiences

• Screening and assessment for traumatic symptoms and PTSD that use empirically validated tools alongside clinical interviews should be considered routine practice in perinatal care

• Psychotherapeutic intervention is considered the first-line treatment for PTSD during the perinatal period

• CBT, EMDR, and exposure are considered evidence-based treatments in this regard, though the limited nature of the existing research is noted

• Pharmacological treatment should only be considered in cases where psychotherapeutic intervention is contraindicated, inaccessible, or ineffective

• Priority should be given to pharmacological treatment when there is significant emotional distress, impairment, or threat to the safety of the mother and/or newborn

• Routine screening and assessment for PTSD is advised in all cases when feasible, and especially in cases involving reproductive loss, intimate partner violence, or histories of sexual violence

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.