Muzik Maria, McGinnis Ellen W, Bocknek Erika, Morelen Diana, Rosenblum Katherine L, Liberzon Israel, Seng Julia, Abelson James L
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
Department of Education, Wayne State University, Detroit, Michigan.
Depress Anxiety. 2016 Jul;33(7):584-91. doi: 10.1002/da.22465. Epub 2016 Jan 6.
Little is known about trajectories of PTSD symptoms across the peripartum period in women with trauma histories, specifically those who met lifetime PTSD diagnoses prior to pregnancy. The present study seeks to identify factors that influence PTSD symptom load across pregnancy and early postpartum, and study its impact on postpartum adaptation.
The current study is a secondary analysis on pregnant women with a Lifetime PTSD diagnosis (N = 319) derived from a larger community sample who were interviewed twice across pregnancy (28 and 35 weeks) and again at 6 weeks postpartum, assessing socioeconomic risks, mental health, past and ongoing trauma exposure, and adaptation to postpartum.
Using trajectory analysis, first we examined the natural course of PTSD symptoms based on patterns across peripartum, and found four distinct trajectory groups. Second, we explored factors (demographic, historical, and gestational) that shape the PTSD symptom trajectories, and examined the impact of trajectory membership on maternal postpartum adaptation. We found that child abuse history, demographic risk, and lifetime PTSD symptom count increased pregnancy-onset PTSD risk, whereas gestational PTSD symptom trajectory was best predicted by interim trauma and labor anxiety. Women with the greatest PTSD symptom rise during pregnancy were most likely to suffer postpartum depression and reported greatest bonding impairment with their infants at 6 weeks postpartum.
Screening for modifiable risks (interpersonal trauma exposure and labor anxiety) and /or PTSD symptom load during pregnancy appears critical to promote maternal wellbeing.
对于有创伤史的女性，尤其是那些在怀孕前就被诊断为终身创伤后应激障碍（PTSD）的女性，围产期PTSD症状的轨迹了解甚少。本研究旨在确定影响孕期和产后早期PTSD症状负荷的因素，并研究其对产后适应的影响。
本研究是对来自更大社区样本的患有终身PTSD诊断的孕妇（N = 319）进行的二次分析，这些孕妇在孕期接受了两次访谈（28周和35周），产后6周再次接受访谈，评估社会经济风险、心理健康、过去和持续的创伤暴露以及产后适应情况。
通过轨迹分析，首先我们根据围产期的模式检查了PTSD症状的自然病程，发现了四个不同的轨迹组。其次，我们探讨了塑造PTSD症状轨迹的因素（人口统计学、历史和孕期因素），并检查了轨迹成员对产妇产后适应的影响。我们发现，儿童虐待史、人口统计学风险和终身PTSD症状计数增加了孕期发作PTSD的风险，而孕期PTSD症状轨迹最好由中期创伤和分娩焦虑预测。孕期PTSD症状增加最多的女性最有可能患产后抑郁症，并且在产后6周报告与婴儿的情感联结受损最大。
在孕期筛查可改变的风险（人际创伤暴露和分娩焦虑）和/或PTSD症状负荷对于促进产妇健康似乎至关重要。
