Posttraumatic Stress Disorder 2 Months After Cesarean Delivery: a Multicenter Prospective Study

Background The prevalence and risk factors of posttraumatic stress disorder (PTSD) after cesarean delivery, outside high-risk contexts, remain unclear Objective To assess posttraumatic stress disorder prevalence and risk factors at 2 months postpartum among a general population of women with cesarean delivery. Study design Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women expected to undergo cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery and postpartum blood loss were prospectively collected. Two months after childbirth, posttraumatic stress disorder profile (presence of PTSD symptoms) and provisional diagnosis (positive screening for diagnosis consistent with a PTSD) were assessed by 2 self-administered questionnaires (Impact of Event Scale Revised (IESR) and Traumatic of Event Scale (TES)). The corrected posttraumatic stress disorder prevalence was estimated with inverse probability weighting to take nonresponse into account. Associations between potential risk factors and posttraumatic stress disorder were analyzed by multivariate logistic or linear regression modeling according to the type of dependent variable. Results In all, 2785 of 4431 women returned the IES-R questionnaire and 2792 the TES (response rates of 62.9% and 63.0%). The prevalence of posttraumatic stress disorder profile was 9.0% (95% confidence interval (CI) 7.8-10.3%) and of provisional diagnosis 1.7% (95%CI 1.2-2.4%). Characteristics associated with a higher risk of posttraumatic stress disorder profile were prepregnancy vulnerability factors - young age, high BMI and Africa-born migrant – and cesarean-related obstetric factors - cesarean delivery after induced labor (adjusted odds ratio [aOR] 1.81, 95%CI 1.14-2.87), postpartum hemorrhage (aOR 1.61, 95%CI 1.04-2.46) and high intensity pain during the postpartum stay (aOR 1.90, 95%CI 1.17-3.11). Women who had immediate skin-to-skin contact with their newborn were at lower risk of posttraumatic stress disorder (aOR 0.66, 95%CI 0.46-0.98), and women with bad memories of delivery on day 2 postpartum at higher risk (aOR 3.20, 95%CI 1.97-5.12). The IES-R and the TES scales yielded consistent results Conclusions Around one in 11 women with cesarean deliveries had posttraumatic stress disorder symptoms at 2 months postpartum. Some obstetric interventions and components of cesarean management may influence this risk