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

From: A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder

Study N Method     Results (in case of ORs: risk vs. reference)
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***
  1. Note*p<0.05. **p<0.01, ***p<0.001, ns: none significance, † significance but the level of significance was not reported.
  2. ‡ GEE: generalized estimating equation.