Studies On The Association Between Postpartum Post-traumatic Stress Disorder And Cesarean Section

1 BACKGROUNDTraumatic events can lead to post-traumatic stress disorder(PTSD).Cesarean section(CS)is a traumatic event for some postpartum women,which may result in postpartum PTSD.However,few evidence on postpartum PTSD is available in China,and the reported association of CS with postpartum PTSD in other countries are inconsistent.Therefore,we hypothesized that women with CS have a high prevalence of postpartum PTSD,and CS is an independent risk factor of postpartum PTSD.First,a systematic review and meta-analysis was carried out to quantify the prevalence of PTSD after CS reported in the literature.Second,a prospective cohort study was conducted to investigate the independent association between CS and postpartum PTSD.This study could provide the latest evidence for early detection,early prevention,and early treatment to women with postpartum PTSD after CS.2 OBJECTIVES(1)To summarize the prevalence of postpartum PTSD after CS.(2)To assess the independent association between CS and postpartum PTSD.3 METHODS(1)The systematic review and meta-analysis:MEDLINE,PsycINFO,EMBASE,CINAHL,CNKI,Wanfang and Vip were searched using PTSD terms crossed with CS terms.The retrieved studies were screened according to inclusion criteria and exclusion criteria.Quality assessment and data extraction were conducted for the included studies.Meta-analysis was performed with R 4.0.3 software to determine the prevalence of postpartum PTSD after CS.(2)The prospective cohort study:Postpartum women were recruited during hospitalization for childbirth in the obstetric ward of a tertiary general hospital in Nanhai District,Foshan City,Guangdong Province based on inclusion criteria and exclusion criteria.Women were assessed using the Edinburgh Postnatal Depression Scale(EPDS)at 3-5 days postpartum in the obstertric ward,and women with EPDS score less than 13,namely negative postpartum depression,were included in the study,and then their sociodemographic and obstetric data were collected.Finally,these women were assessed using PTSD Checklist-Civilian version(PCL-C)at 42 days postpartum in the obstetrics outpatient of the hospital.Log binomial regression model was used to analyse the independent association between CS and postpartum PTSD.4 RESULTS(1)The systematic review and meta-analysis:Fourteen eligible studies were included in this review.The total sample size was 4,023,of whom 544 were identified as suffering from PTSD.Meta-analysis showed that the prevalence of postpartum PTSD after CS was 12.9%(95%CI,8.0 to 18.8).The prevalence of postpartum PTSD after emergency CS was 10.3%(95%CI,1.7 to 24.9)and the prevalence of postpartum PTSD after elective CS was 7.1%(95%CI,0.7 to 19.4).Subgroup analysis found that prevalence of PTSD after CS differed according to study settings,time interval from childbirth to assessment of PTSD,and type of participants.Meta-regression analysis showed that study settings and type of study participants were significant sources of heterogeneity.(2)The prospective cohort study:A total of 800 women with EPDS scores less than 13(namely negative postpartum depression)were recruited in this cohort study,of whom 759(94.88%)completed PCL-C assessment and were included in the final analysis.The prevalence of postpartum PTSD in these included women was 12.12%.The prevalence of postpartum PTSD was 8.18%in women with vaginal delivery and 17.55%in women with CS.After adjusting for confounding factors(family support,parity,anxiety during pregnancy,dismay during pregnancy,and fear of birth),women with elective CS(RRF=1.70,95%CI,1.03 to 2.87)and emergency CS(RR=1.95,95%CI,1.08 to 3.83)had an increased risk of developing postpartum PTSD compared with women with vaginal delivery.5 CONCLUSIONS(1)Prevalence of PTSD was high among women with CS,especially among those with emergency CS.(2)CS may be an important independent risk factor of postpartum PTSD.(3)The susceptibility to PTSD appears to vary based on elective/emergency CS,study methodology,type of participants,and country of study.Further targeted research is needed to elucidate the role of these factors in association between CS and PTSD.