Pregnant Women’s Trauma Exposure & Posttraumatic Stress Symptoms (PTSS)

Wamser, R., & Ferro, R. A. (2024). Cumulative trauma, posttraumatic stress, and obstetric and perinatal outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 16(8), 1374–1381. https://doi.org/10.1037/tra0001579

Rationale

Previous research has established links between trauma exposure, posttraumatic stress disorder (PTSD), and various physical health conditions (Schnurr & Green, 2004; Yehuda et al., 2015).

Some studies have indicated that trauma and PTSD may adversely impact obstetric and perinatal outcomes (Seng et al., 2010; Shaw et al., 2014, 2017; Yildiz et al., 2017).

However, the relationships between trauma exposure, posttraumatic stress symptoms (PTSS), and specific pregnancy outcomes remain understudied and unclear.

This study aimed to expand on previous research by examining both cumulative trauma exposure and PTSS in relation to multiple obstetric and perinatal outcomes, including nonviable pregnancies, pregnancy complications, preterm birth, and low birth weight.

The researchers sought to provide a more comprehensive understanding of how traumatic stress may impact women’s pregnancy experiences and outcomes.

Method

The study used a cross-sectional design with self-report measures to assess trauma exposure, posttraumatic stress symptoms, and various obstetric and perinatal outcomes.

Participants completed online questionnaires via Qualtrics, including measures of trauma exposure, posttraumatic stress symptoms, and a perinatal questionnaire assessing various pregnancy outcomes and complications.

Sample

The sample consisted of 226 trauma-exposed women who had been pregnant at least once. Participants were recruited from Amazon’s Mechanical Turk (MTurk; 63.3%) and a midwestern university (36.7%).

The mean age was 40.54 years (SD = 13.03, range = 19-71).

The majority identified as White (64.7%) and non-Hispanic/Latinx (93.4%).

Measures

• Life Stressor Checklist-Revised (LSC-R): Assessed lifetime trauma exposure and significant life stressors.
• PTSD Checklist-Civilian 5 (PCL-5): Measured posttraumatic stress symptoms.
• Perinatal Questionnaire: Assessed various pregnancy outcomes and complications.

Statistical measures

Linear and logistic regression models were used to examine the relationships between cumulative trauma, PTSS, and various obstetric and perinatal outcomes.

Covariates included recruitment source and number of pregnancies.

Results

Hypothesis 1: Higher levels of PTSS and cumulative trauma would be associated with a greater number of nonviable pregnancies.

Result: Partially supported. Higher levels of PTSS were associated with a greater number of nonviable pregnancies (β = .18, p = .002), but cumulative trauma was not related.

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Hypothesis 2: Higher levels of PTSS and cumulative trauma would be associated with more pregnancy complications.

Result: Not supported. Neither PTSS nor cumulative trauma was related to the number of pregnancy complications.

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Hypothesis 3: Higher levels of PTSS and cumulative trauma would be associated with increased likelihood of preterm birth.

Result: Partially supported. Greater cumulative trauma was associated with increased odds of preterm birth (OR = 1.16, p = .042), but PTSS was not related.

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Hypothesis 4: Higher levels of PTSS and cumulative trauma would be associated with increased likelihood of low birth weight.

Result: Partially supported. Higher levels of PTSS were associated with increased odds of low birth weight (OR = 1.03, p = .016), but cumulative trauma was not related.

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Exploratory analysis: Examining the relationship between PTSS, cumulative trauma, and abortions.

Result: Higher levels of PTSS were associated with a greater number of abortions (β = .20, p = .002), but cumulative trauma was not related.

Insight

This study provides evidence that both cumulative trauma exposure and posttraumatic stress symptoms can negatively impact women’s pregnancy outcomes, but in different ways.

PTSS appears to have a broader impact, being associated with nonviable pregnancies, low birth weight, and abortions. In contrast, cumulative trauma exposure was specifically linked to preterm birth.

These findings extend previous research by examining both trauma exposure and symptoms simultaneously, allowing for a more nuanced understanding of their respective impacts.

The study also highlights the importance of assessing specific obstetric and perinatal outcomes separately, as the relationships between traumatic stress and different outcomes varied.

Future research should investigate the temporal relationships between trauma exposure, PTSS, and pregnancy outcomes through longitudinal studies.

Additionally, exploring the impact of specific types of trauma, especially childhood trauma, could provide further insights into these relationships.

Clinical Implications

The findings suggest that healthcare providers, particularly primary care physicians and obstetricians/gynecologists, should assess trauma exposure and PTSS among pregnant women and those planning to conceive.

This could lead to early identification of women at higher risk for adverse pregnancy outcomes and allow for appropriate interventions or referrals to mental health specialists.

For clinical practice, these results emphasize the importance of addressing trauma-related symptoms in prenatal care.

Developing and implementing trauma-informed care approaches in obstetric settings could potentially improve pregnancy outcomes for women with trauma histories or PTSS.

Future research should focus on longitudinal studies to establish causal relationships between traumatic stress and pregnancy outcomes.

Additionally, investigating potential biological mechanisms linking PTSS to adverse pregnancy outcomes could inform targeted interventions.

Strengths

• Examined both cumulative trauma exposure and PTSS simultaneously
• Investigated multiple obstetric and perinatal outcomes
• Included a relatively large sample size
• Used validated measures for assessing trauma exposure and PTSS
• Recruited participants from multiple sources (MTurk and university) to increase sample diversity

Limitations

• Cross-sectional design limits causal inferences
• Reliance on self-report measures may introduce reporting biases and recall errors
• Lack of assessment of other biopsychosocial risk factors for adverse pregnancy outcomes
• Limited racial and ethnic diversity in the sample
• Did not examine specific types of trauma or timing of traumatic experiences in relation to pregnancies
• Did not assess the duration or chronicity of PTSS

References

Primary reference

Wamser, R., & Ferro, R. A. (2024). Cumulative trauma, posttraumatic stress, and obstetric and perinatal outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 16(8), 1374–1381. https://doi.org/10.1037/tra0001579

Other references

Schnurr, P. P., & Green, B. L. (Eds.). (2004). Trauma and health: Physical health consequences of exposure to extreme stress. American Psychological Association. https://doi.org/10.1037/10723-010

Seng, J. S., Rauch, S. A. M., Resnick, H., Reed, C. D., King, A., Low, L. K., McPherson, M., Muzik, M., Abelson, J., & Liberzon, I. (2010). Exploring posttraumatic stress disorder symptom profile among pregnant women. Journal of Psychosomatic Obstetrics and Gynaecology, 31(3), 176-187. https://doi.org/10.3109/0167482X.2010.486453

Shaw, J. G., Asch, S. M., Kimerling, R., Frayne, S. M., Shaw, K. A., & Phibbs, C. S. (2014). Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstetrics & Gynecology, 124(6), 1111-1119. https://doi.org/10.1097/AOG.0000000000000542

Shaw, J. G., Asch, S. M., Katon, J. G., Shaw, K. A., Kimerling, R., Frayne, S. M., & Phibbs, C. S. (2017). Post-traumatic stress disorder and antepartum complications: A novel risk factor for gestational diabetes and preeclampsia. Paediatric and Perinatal Epidemiology, 31(3), 185-194. https://doi.org/10.1111/ppe.12349

Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., Hobfoll, S. E., Koenen, K. C., Neylan, T. C., & Hyman, S. E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 1(1), Article 15057. https://doi.org/10.1038/nrdp.2015.57

Yildiz, P. D., Ayers, S., & Phillips, L. (2017). The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. Journal of Affective Disorders, 208(3), 634-645. https://doi.org/10.1016/j.jad.2016.10.009

Keep Learning

Socratic questions for a college class to discuss this paper:

1. How might the relationship between trauma exposure, PTSS, and pregnancy outcomes differ across various cultural contexts?
2. What ethical considerations should researchers keep in mind when studying trauma and pregnancy outcomes?
3. How could healthcare systems be restructured to better address the needs of pregnant women with trauma histories or PTSS?
4. In what ways might the impact of trauma on pregnancy outcomes contribute to intergenerational cycles of trauma?
5. How might the findings of this study inform public health policies related to maternal and child health?