Even for healthy women, pregnancy can be an intensely emotional experience. Researchers wondered how being pregnant would effect women who have lived through something awful enough to cause post-traumatic stress disorder (PTSD).
Contrary to what they expected, a new study shows that for the majority of women, pregnancy may actually reduce PTSD symptoms— or at least not cause a flare-up.
But for about one in four women with PTSD, the opposite is true. Not only do their symptoms get worse as their pregnancy advances, but their ability to bond with their newborn suffers and they face a high risk of postpartum depression.
Of the 319 women in the study, more than half had high PTSD symptoms in the first part of pregnancy. All of the women in this group experienced a decrease in symptoms as they got closer to giving birth. Women who had low levels of symptoms early on stayed about the same.
Message of Hope
But for women who suffered a new stress or trauma during pregnancy, or who had the most anxiety about giving birth, symptoms got worse both during pregnancy and after birth.
“We hope our results give a message of hope that women who have a past diagnosis of PTSD aren’t all headed for a worsening while they’re pregnant,” says Maria Muzik, a psychiatrist at the University of Michigan. “But we also have highlighted a vulnerable group that has a heightened risk of worsening symptom and postnatal issues that could have lasting effects for both mother and child.”
PTSD can be caused by many things—including combat, car crashes, being robbed or raped, living through a natural disaster or house fire, or being the victim of abuse in childhood or adulthood. With so many possible causes, many women may not have had a formal diagnosis of PTSD before their pregnancy, but may be suffering lasting effects from their trauma.
Researchers cast a wide net to find women for the study.
Nurses at prenatal clinics run by three academic health centers, including ones that served mostly women who rely on public insurance, invited thousands of women to participate in a larger study. The new data come from the subset of women who met the formal diagnostic criteria for PTSD either at the time of their pregnancy or in their past, based on detailed interviews using standard measures.
The team interviewed the women at two points during their pregnancy, and interviewed about half the women again in the first six weeks of motherhood.
The researchers saw four groups emerge when they looked at the results of the surveys done during pregnancy: those who started high and got either moderately or substantially better, those who started low and stayed the same, and those who started relatively low but got worse.
Women with the strongest social support networks during pregnancy appeared to be protected from the risk of worsening PTSD, meaning partners, relatives, and friends can make a real difference for a pregnant woman.
Muzik hopes that the new results will encourage providers who care for pregnant women to make PTSD screening part of their regular prenatal care.
“With a few questions and screening measures, they can identify women who are experiencing risk factors, and heighten their awareness for support and treatment,” she says. “Preventing the worsening of symptoms could reduce their chance of post-birth illness, and protect their future child from the lasting ill effects that a mother’s mental illness can have.”
Muzik, M., McGinnis, E. W., Bocknek, E., Morelen, D., Rosenblum, K. L., Liberzon, I., Seng, J. and Abelson, J. L. (2016) PTSD Symptoms Across Pregnancy And Early Postpartum Among Women With Lifetime PTSD Diagnosis Depress. Anxiety. doi: 10.1002/da.22465