Perinatal trauma with and without loss experiences

Panic disorder during pregnancy and the first three years after delivery: a systematic review

BACKGROUND

Panic disorder (PD) is highly prevalent during the peripartum period. The aim of this systematic review was to summarize evidence on risk factors and course patterns of peripartum PD as well as maternal, infant or dyadic outcomes during the first three years after delivery.

METHODS

A literature search was conducted according to PRISMA guidelines. Inclusion criteria were: (1) a diagnosis of PD or panic attacks during pregnancy, (2) risk factors and course as well as maternal, infant or dyadic outcomes measured in pregnancy and/or up to 3 years postpartum (3) peer-reviewed articles in English or German published between 1980 and April 2024. After screening of n = 2,740 records, n = 75 records based on n = 64 projects were eligible for this systematic review.

RESULTS

Overall, n = 47 studies investigated the course of PD during the peripartum period, n = 23 studies examined the associations of PD and obstetric, neonatal or infant outcomes, and n = 5 studies focused on the associations of PD and characteristics of the mother-infant dyad. We found (1) no common trajectory, but heterogeneous courses of maternal PD in the peripartum period, (2) associations of maternal PD with birth complications and subsequent postpartum depression, and (3) evidence for associations of PD with infant and dyadic outcomes.

LIMITATIONS

Diverse outcome measures in recent original publications did not allow for a meta-analytic approach.

CONCLUSION

Heterogenous courses and outcomes of peripartum PD require comprehensive monitoring of affected mothers and their infants. There is a need for further longitudinal investigations into familial transmission of anxiety disorders.

Obsessive-compulsive disorder symptoms and intrusive thoughts in the postpartum period: Associations with trauma exposure and PTSD symptoms

In a community sample of trauma-exposed postpartum individuals (N = 167; mean age = 30, 90% White; 61.7% completed bachelor's degree or higher) longitudinally completed self-report measures on PTSD, depressive, and Obsessive-compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms (r = 0.32- 0.49, p < 0.001), preoccupation with postpartum-specific intrusive thoughts (r = 0.32-0.45, p < 0.001), and preoccupation with neutralising strategies (r = 0.21-0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum-specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non-clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.

The Association between Cesarean Section Delivery and Child Behavior: Is It Mediated by Maternal Post-Traumatic Stress Disorder and Maternal Postpartum Depression?

Cesarean sections (C-sections) account for up to 21% of births worldwide. Studies have linked delivery via C-section with an increased risk of child behavior problems, such as internalizing and externalizing behaviors. Maternal postpartum depression (PPD) is also linked to child behavioral problems and may play a mediating role in the association between the mode of delivery and child behavior. Mixed findings between mode of delivery and PPD may be due to a failure to distinguish between C-section types, as unplanned/emergency C-sections are linked to post-traumatic stress disorder (PTSD), which has been linked to PPD. The objectives of this study were to determine whether, (1) compared with spontaneous vaginal delivery (SVD) and planned C-section, unplanned/emergency C-sections are associated with increased child behavior problems at two to three years of age and (2) maternal PTSD and PPD mediate the association between delivery type and child behavior problems. A secondary data analysis was conducted on 938 mother-child dyads enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Conditional process modeling was employed. Child behavior was assessed using the Child Behavior Checklist (CBCL) 1.5-5 years, and maternal PPD and PTSD were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ), respectively. No associations were found between delivery type and child behaviors; however, the indirect effect of emergency C-section on child behaviors was significant via the mediating pathway of maternal PTSD on PPD symptoms.

The mental health impact of perinatal loss: A systematic review and meta-analysis

Perinatal loss can pose a significant risk to maternal mental health. There is limited data on the strength of association between perinatal loss and subsequent common mental health disorders (CMHD) such as anxiety, depression and post-traumatic symptoms (PTS). A systematic review and meta-analysis identified studies with control groups, published between January 1995 and March 2020 reporting validated mental health outcomes following perinatal loss. We identified 29 studies from 17 countries, representing a perinatal loss sample (n = 31,072) and a control group of women not experiencing loss (n = 1,261,517). We compared the likelihood of increased CMHD in both groups. Random-effects modelling on suggested that compared to controls, perinatal loss was associated with increased risk of depressive (RR = 2.14, 95% CI = 1.73-2.66, p < 0.001, k = 22) and anxiety disorders (RR = 1.75, 95% CI = 1.27-2.42, p < 0.001, k = 9). Compared to controls, Perinatal loss was also associated with increased depression (SMD = 0.34, 95% CI = 0.20-0.48, p < 0.001, k = 12) and anxiety scores (SMD = 0.35, 95% CI = 0.12-0.58, p < 0.003, k = 10). There were no significant effects for post-traumatic stress (PTS) outcomes (k = 3). Our findings confirm that anxiety and depression levels following perinatal loss are significantly elevated compared to "no loss" controls (live-births, non pregnant from community, or difficult live births). Elevated depression and anxiety rates were also reported for those who experienced loss during later stages of pregnancy. Assessing mental health following loss is a maternal health priority.