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The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis
Abstract
Background Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time.Methods PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.Results 59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum.Limitations Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters.Conclusions PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.
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Maternal coping, appraisals and adjustment following diagnosis of fetal anomaly
Horsch, A., Brooks, C., & Fletcher, H. K. (2013) · Prenatal Diagnosis · doi:10.1002/pd.4207 · Cited by 50
Giving Birth with Rape in One's Past: A Qualitative Study
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Prenatal reflective functioning in primiparous women with a high-risk profile.
Smaling, H. J. A., Huijbregts, S. C. J., Suurland, J., Van Der Heijden, K. B., Van Goozen, S. H. M., & Swaab, H. (2015) · Infant Mental Health Journal · doi:10.1002/imhj.21506 · Cited by 48
Psychological trauma symptoms of operative birth
Gamble, J. A., & Creedy, D. K. (2005) · British Journal of Midwifery · doi:10.12968/bjom.2005.13.4.17981 · Cited by 42
Rowe, H. J., Sperlich, M. I., Cameron, H., & Seng, J. S. (2014) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/1552-6909.12312 · Cited by 42
Mahenge, B., Stöckl, H., Likindikoki, S. L., Kaaya, S., & Mbwambo, J. (2015) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2015.04.032 · Cited by 39
Cognitive Predictors and Risk Factors of PTSD Following Stillbirth: A Short‐Term Longitudinal Study
Horsch, A., Jacobs, I., & McKenzie‐McHarg, K. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.21997 · Cited by 37
The importance of the DSM-IV E and F criteria in self-report assessments of PTSD
Boals, A., & Hathaway, L. M. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.10.004 · Cited by 35
The Oxford Handbook of Perinatal Psychology
Greil, A. L., Schmidt, L., & Peterson, B. D. (2014) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780199778072.001.0001 · Cited by 35
The Efficacy of EMDR Early Interventions
Shapiro, E., & Maxfield, L. (2019) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.13.4.291 · Cited by 34
Seng, J. S., Miller, J. M., Sperlich, M. I., van de Ven, C. J. M., Brown, S. L., Carter, C. S., & Liberzon, I. (2013) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2012.694594 · Cited by 33
Annagür, B. B., Tazegül, A., & Gündüz, Ş. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.05.008 · Cited by 30
Kim, H. G., Harrison, P. A., Godecker, A. L., & Muzyka, C. N. (2013) · Maternal and Child Health Journal · doi:10.1007/s10995-013-1333-7 · Cited by 30
Hyperarousal symptoms after traumatic and nontraumatic births
Ayers, S., Wright, D. B., & Ford, E. M. (2015) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2015.1004164 · Cited by 27
Zambaldi, C. F., Cantilino, A., & Sougey, É. B. (2011) · Archives of Women s Mental Health · doi:10.1007/s00737-011-0224-4 · Cited by 26
Soltani, N. S., Abedian, Z., Mokhber, N., & Esmaily, H. (2015) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.17865 · Cited by 21
Quispel, C., Schneider, T. A. J., Hoogendijk, W. J. G., Bonsel, G. J., & den Berg, M. P. L. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-015-0480-9 · Cited by 18
Spyridou, A., Schauer, M., & Ruf‐Leuschner, M. (2015) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-015-0462-y · Cited by 17
Posttraumatic Stress During Pregnancy and the Postpartum Period
Ayers, S., & Ford, E. (2014) · Oxford Handbooks Online · doi:10.1093/oxfordhb/9780199778072.013.18 · Cited by 15
Spyridou, A., Schauer, M., & Ruf‐Leuschner, M. (2014) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-014-0030-7 · Cited by 15
Major Depression and PTSD in Pregnant Smokers Enrolled in Nicotine Gum Treatment Trial
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The Prevalence of Post Traumatic Stress Disorder after Childbirth Pre-Eclampsia and Related Factors
Abedian, Z., Soltani, N. S., Mokhber, N., & Esmaeily, H. (2013) · Cited by 6
Barbero (2014) · doi:10.1016/j · Cited by 1
Flagged first, then by citations
Research works printed but not linked: 1
- Busari, 2010, Prevalence of risk factors and posttraumatic stress disorder in low income pregnant women, Eur. J. Soc. Sci., 14, 480
Cited by
Sorted by citations
Cook, N., Ayers, S., & Horsch, A. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.07.045 · Cited by 481
Development of a Measure of Postpartum PTSD: The City Birth Trauma Scale
Ayers, S., Wright, D. B., & Thornton, A. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00409 · Cited by 336
Childbirth Induced Posttraumatic Stress Syndrome: A Systematic Review of Prevalence and Risk Factors
Dekel, S., Stuebe, C., & Dishy, G. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00560 · Cited by 283
Pregnancy as a period of risk, adaptation, and resilience for mothers and infants
Davis, E. P., & Narayan, A. J. (2020) · Development and Psychopathology · doi:10.1017/s0954579420001121 · Cited by 297
“In lower-income samples, PTSD symptoms may be clinically elevated in as many as 18%–29% of pregnant women or more, particularly if women are high-risk due to childhood adversity and pregnancy complications (Narayan et al., 2017; Narayan, Atzl, et al., 2019; Yildiz, Ayers, & Phillips, 2017).”
Basu, A., Kim, H. H., Choi, K. W., Charron, L., Kelsall, N., Basaldua, R., Hernández–Dı́az, S., Wyszynski, D. F., & Koenen, K. C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0249780 · Cited by 278
Metadata
- Authors
- Yildiz, P. D., Ayers, S., & Phillips, L.
- Affiliations
- City, University of London (GB)
- Corresponding author
- Ayers, Susan
- ORCID
- Ayers, Susan
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 208
- Pages
- 634-645
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2542924774
- Cited by
- 768
- References
- 99
- Citations by year
- 2026: 90 · 2025: 97 · 2024: 99 · 2023: 97 · 2022: 97 · 2021: 92 · 2020: 111 · 2019: 47 · 2018: 24 · 2017: 13
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Worcester Research and Publications (University of Worcester) (acceptedVersion)
- City Research Online (City University London) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- post-traumatic stress disorder, postpartum PTSD, pregnancy, childbirth, prevalence, high-risk groups, obstetric care
- MeSH terms
- Adaptation, Psychological, Female, Humans, Pregnancy, Risk Factors, Stress Disorders, Post-Traumatic, Prevalence, Depression, Postpartum, Parturition, Delivery, Obstetric, Postpartum Period
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