Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review

Natalie Cook; Susan Ayers; Antje Horsch

doi:10.1016/j.jad.2017.07.045

Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review

J Affect Disord. 2018 Jan 1:225:18-31. doi: 10.1016/j.jad.2017.07.045. Epub 2017 Jul 27.

Authors

Natalie Cook¹, Susan Ayers², Antje Horsch³

Affiliations

¹ The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom. Electronic address: Natalie.Cook@nhs.net.
² Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom. Electronic address: susan.ayers@city.ac.uk.
³ Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre-Decker 2, CH-1011 Lausanne, Switzerland. Electronic address: antje.horsch@chuv.ch.

PMID: 28777972
DOI: 10.1016/j.jad.2017.07.045

Abstract

Background: Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.

Method: A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.

Results: 26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.

Limitations: Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity.

Conclusion: Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.

Keywords: Birth outcomes; Child development; Mother-infant relationship; Postnatal; Posttraumatic stress disorder; Pregnancy.

Publication types

Review
Systematic Review

MeSH terms

Depression, Postpartum / epidemiology
Depression, Postpartum / psychology*
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Mothers / psychology*
Parturition / psychology*
Postpartum Period / psychology*
Pregnancy
Pregnancy Outcome / epidemiology
Pregnancy Outcome / psychology*
Premature Birth / psychology
Stress Disorders, Post-Traumatic / epidemiology
Stress Disorders, Post-Traumatic / psychology*