Preventing Post-Traumatic Stress Disorder following Childbirth: A Systematic Review and Meta-Analysis.

OBJECTIVE: Women can develop post-traumatic stress disorder (PTSD) in response to experienced or perceived traumatic, often medically complicated, childbirth; U.S. prevalence of these events remains high. Currently, no recommended treatment exists in routine care for preventing or mitigating maternal childbirth-related PTSD (CB-PTSD). We provide a systematic review and meta-analysis of clinical trials testing any therapy to prevent or treat CB-PTSD.

DATA SOURCES: PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, Scopus, and CENTRAL were searched for eligible trials published through September 2023.

STUDY ELIGIBILITY CRITERIA: Trials were included if they were interventional, evaluated any therapy for CB-PTSD, for indication of symptoms or before PTSD onset, and written in English.

STUDY APPRAISAL AND SYNTHESIS METHODS: Independent coders extracted sample characteristics and intervention information of eligible studies and evaluated trials using Downs and Black's quality checklist and Cochrane's method for risk of bias.

RESULTS: 41 studies (32 randomized controlled trials, 9 non-randomized trials) were reviewed. They tested brief psychological therapies entailing debriefing, trauma-focused (including Cognitive Behavioral Therapy and Expressive Writing), memory consolidation/reconsolidation blockage, mother-infant focused, and educational interventions. Trials targeted secondary prevention to buffer CB-PTSD usually after traumatic childbirth (n=24), tertiary preventions in women with probable CB-PTSD (n=14), and primary prevention during pregnancy (n=3). Meta-analysis of combined randomized secondary preventions showed moderate effects for reducing CB-PTSD symptoms against treatment as usual (standardized mean difference, SMD =-0.67; 95% CI -0.92,-0.42). Single-session therapy within 96 hours postpartum was helpful (SMD=-0.55). Brief structured trauma-focused therapies and semi-structured midwife-led dialogue-based psychological counseling showed the largest effects (SMD=-0.95 and SMD=-0.91). Other treatment approaches (e.g., Tetris game, mindfulness, mother-infant focused) warrant more research. Tertiary preventions represented smaller effects vs. secondary, but are potentially clinically meaningful (SMD = -0.37 (-0.60; -0.14)). Antepartum educational approaches may help, but insufficient empirical evidence exists.

CONCLUSIONS: Brief trauma-focused and non-trauma-focused psychological therapies delivered in in the early period following traumatic childbirth offer a critical and feasible opportunity to buffer symptoms of childbirth-related PTSD. Future research integrating diagnostics and biological measures can inform treatment utility and the mechanisms at work.