Table 7 Association and effect size of maternal morbidity and other variables on PTSD (profile/symptoms)

Adewuya et al., 2006

876

Stepwise multiple regressions

M.I.N.I

PTSD

6 wks

Admission due to pregnancy complication: yes vs. no

Adjusted OR: 11.9 ^†

(95%CI: 6.4–22.1)

Mode of delivery

- Instrumental vs. spontaneous vaginal

Adjusted OR: 7.9 ^†

(95%CI: 3.9–16.2)

- EmCS vs. spontaneous vaginal

Adjusted OR: 7.3 ^†

(95%CI:3.5–15.2)

- ElCS vs. spontaneous vaginal

Adjusted OR: 2.0

(95%CI: 0.4–8.9)

Mode of placental removal: manual vs. normal

Adjusted OR: 5.0 ^†

(95%CI: 2.4–10.1)

Perceived control in childbirth: LAS < 40 vs. > 40

Adjusted OR: 5.1 ^†

(95%CI: 2.7–9.5)

Ayers, 1999

220

Mann Whitney Spearman's correlation

IES

Intrusions (sub-sum score)

6 wks

Delivery complication: presence vs. absence

ns

Amount of blood loss

ns

Kruskal-Wallis

Type of delivery (eg. EmCS)

ns

Partial correlation (removing an effect of PTSD symptoms in pregnancy)

Appraising birth as traumatic

Partial correlation β=.20 ** (one tailed)

Different from how women wanted to be

Partial correlation β=.17*

201

6 mths

Delivery complication: presence vs. absence

ns

Amount of blood loss

ns

Type of delivery (eg. EmCS)

ns

Appraising birth as traumatic

Partial correlation β=.19 ** (one tailed)

Different from how women wanted to be

Partial correlation β=.22**

220

Avoidance (sub-sum score)

6 wks

Delivery complication: presence vs. absence

ns

Amount of blood loss

ns

Type of delivery (eg. EmCS)

ns

Appraising birth as traumatic

Partial correlation β=.23 ** (one tailed)

Different from how women wanted to be

Partial correlation β=.35***

201

6 mths

Delivery complication: presence vs. absence

Unadjusted U=2553 *

Amount of blood loss

ns

Type of delivery (eg. EmCS)

ns

Appraising birth as traumatic

Partial correlation β=.24 *** (one tailed)

Different from how women wanted to be

Partial correlation β=.29 ***

Baecke et.al, 2009

169

Method for ORs: not stated

IES

PTSD symptoms

6-18 mths

Preterm preeclampsia vs. Term, uneventful

(Adjusted?) OR: 6.2^†

(95%CI: 2.5-15.8)

Preterm preeclampsia vs. Term preeclampsia

(Adjusted?) OR: 6.2^†

(95%CI: 1.3-30.1)

Preterm, no complication vs. Term, uneventful

(Adjusted?) OR: 5.5^†

(95%CI: 2.0-15.2)

Cohen et al., 2004

184

Multivariable logistic regression

DTS

Postpartum stress (high/low)

8-10 wks

Maternal complications: 2+ vs. 0-1

Adjusted OR: 4.0^†

(95%CI: 1.3-12.8)

Depression during pregnancy: yes vs. no

Adjusted OR: 18.9^†

(95%CI: 5.8-62.4)

History of traumatic events: 2+ vs. 0–1

Adjusted OR: 3.2^†

(95%CI: 1.2-8.3)

Born in Canada vs. Not born in Canada

Adjusted OR: 3.2^†

(95%CI: 1.3-8.1)

Income (Canadian $)

- lowest (<$32,000) vs. high (>$8000)

Adjusted OR: 0.1^†

(95%CI: 0.02-0.5)

- middle ($32,000-80,000) vs. high (>$8000)

Adjusted OR: 0.4^†

(95%CI: 0.2-0.8)

Creedy et al., 1999

499

Simple regression

IES

PTSD symptom severity (sum score)

4-6 wks

Preparedness for labour and delivery

ns

Stepwise multiple regressions

Maternal complications

ns

EmCS

Adjusted β=.20***

Forceps delivery

Adjusted β=.17***

Vacuum delivery

Adjusted β=.14**

Post-delivery pain

Adjusted β=.16***

Neonatal complications

Adjusted β=.10*

Hierarchical multiple regression

Final model (Accounted for 21% of variance)

Perception of maternity care (step 1)

Adjusted β=.-32***

Obstetric intervention (step 2)

Adjusted β=.26***

141

Multiple regression

3 mths

Final model (Accounted for 24% variance)

Preparedness for labour and delivery

Adjusted β=.-16*

Obstetric intervention

Adjusted β=.15*

Perception of maternity care

Adjusted β=.42***

Engelhard et.al, 2002

113

Hierarchical multiple regression

PSS-SR

PTSD symptom severity

Within 2 yrs

Final mode (Accounted for 61% of the variance)

Gestational age at admission (step 1)

ns

Peritraumatic distress (step 2)

ns

Peritraumatic dissociation (step 2)

Adjusted β=.27**

Negative interpretations (step 3)

Adjusted β=−.40*

Thought suppression (step 3)

Adjusted β=−.25*

Hoedjes et al., 2011

149

Logistic regression for each variable (adjusting only for assessment time – 6 and 12 weeks postpartum using GEE^‡)

SRIP

PTSD profile (yes/no)

6-12 wks

Severity of preeclampsia: severe vs. mild

Unadjusted OR: 5.0*

(95%CI: 0.6–38.8)

Mode of delivery: CS vs. vaginal

Unadjusted OR: 8.4*

(95%CI: 1.1–65.5)

Age

Unadjusted OR: 0.6*

(95%CI: 0.4–0.7)

Gestational age at delivery

Unadjusted OR: 0.8*

(95%CI: 0.7–1.0)

Intrusions (yes/no)

Severity of preeclampsia: severe vs. mild

Unadjusted OR: 5.5*

(95%CI: 1.6–18.7)

Mode of delivery: CS vs. vaginal

Unadjusted OR: 4.3*

(95%CI: 1.7–10.6)

Admission to NICU: yes vs. no

Unadjusted OR: 5.9*

(95%CI: 2.4–15.0)

Perinatal death: yes vs. no

Unadjusted OR: 7.1*

(95%CI: 1.8–27.8)

Age

Unadjusted OR: 0.8*

(95%CI: 0.7–0.9)

Gestational age at delivery

Unadjusted OR: 0.9*

(95%CI: 0.8–0.9)

Birth weight

Unadjusted OR: 0.5*

(95%CI: 0.3–0.8)

Avoidance (yes/no)

Mode of delivery: CS vs. vaginal

Unadjusted OR: 3.9*

(95%CI: 1.1–13.9)

Admission to NICU: yes vs. no

Unadjusted OR: 4.3*

(95%CI: 1.2–15.6)

Age

Unadjusted OR: 0.7*

(95%CI: 0.6–0.8)

Gestational age at delivery

Unadjusted OR: 0.9*

(95%CI: 0.8–0.9)

Birth weight

Unadjusted OR: 0.4*

(95%CI: 0.2–1.0)

Hyperarousal (yes/no)

Severity of preeclampsia: severe vs. mild

Unadjusted OR: 3.0*

(95%CI: 1.2–7.9)

Mode of delivery: CS vs. vaginal

Unadjusted OR: 2.6*

(95%CI: 1.2–5.7)

Admission to NICU: yes vs. no

Unadjusted OR: 2.8*

(95%CI: 1.3–5.8)

Perinatal death: yes vs. no

Unadjusted OR: 6.6*

(95%CI: 1.1–39.6)

Age

Unadjusted OR: 0.9*

(95%CI: 0.8–1.0)

Gestational age at delivery

Unadjusted OR: 0.9*

(95%CI: 0.8–1.0)

Birth weight

Unadjusted OR: 0.6*

(95%CI: 0.4–0.8)

Lev-Wiesel et al, 2009

1071

Linear multiple regression

PSS-I

PTSD symptoms severity

6 mths

Final model (Accounted for 41% of the variance)

(sum score)

Subjective pain and distress during delivery

Adjusted β=.51***

PTS during pregnancy

Adjusted β=.04

Delivery complications

Adjusted β=.04

Depression during pregnancy

Adjusted β=.15***

History of traumatic events

Adjusted β=.08**

High risk pregnancy

Adjusted β=.03

Sorenson & Tschetter, 2010

71

Point-biserial correlation coefficient

PTCS

Posttraumatic childbirth stress (low/high)

6–7 mths

Maternal complications: yes vs. no

Unadjusted rpbs = 0.28 ^†

Infant complications: yes vs. no

Unadjusted rpbs = 0.25 ^†

Stramrood et al, 2010

175

Hierarchical multiple regression

PSS-SR

PTSD symptoms severity

6 wks

Final model (Accounted for 39% of the variance)

A history of depression (step 1)

Adjusted β=.23**

BDI scores during pregnancy (step 1)

Adjusted β=.33***

Death of infant (step 2)

Adjusted β=.29***

Hospital admission of the infant (step 2)

ns

Birth weight (step 2)

ns

Diagnosis of the mother (PE vs PPROM) (step 2)

ns

CS (step 2)

ns

Stramrood et al, 2011

428

Hierarchical multiple regression

TES-B

PTSD symptoms severity (sum score)

2 to 6 mths

Final model (Accounted for 41% of the variance)

Country of origin (step 1)

Adjusted β=.004

Primiparity (step 1)

Adjusted β=.06

Preeclampsia/HELLP syndrome (step 1)

Adjusted β=.08

Hypertension (step 1)

Adjusted β=.04

Preterm delivery (step 1)

Adjusted β=.04

Secondary/tertiary care (step 2)

Adjusted β=−.09

Hospital delivery (step 2)

Adjusted β=−.05

Induction of labour (step 2)

Adjusted β=−.02

Instrumental vaginal delivery (step 2)

Adjusted β=−.08

Unplanned caesarean section (step 2)

Adjusted β=.11**

Postpartum haemorrhage (>1L) (step 2)

Adjusted β=.06

Manual placenta removal (step 2)

Adjusted β=.04

Perinatal death (step 2)

Adjusted β=.06

N(I)CU admittance (infant) (step 2)

Adjusted β=.05

ICU admittance (mother) (step 2)

Adjusted β=.03

Fear of childbirth (high) (step 3)

Adjusted β=.02

Delivery worse than expected (step 3)

Adjusted β=.01

Intensity of pain (high) (step 3)

Adjusted β=.11*

Sense of Coherence (low) (step 3)

Adjusted β=.53***