A Systematic Review of Interventions for Prevention and Treatment of Post-Traumatic Stress Disorder Following Childbirth.
medRxiv
; 2023 Aug 23.
Article
em En
| MEDLINE
| ID: mdl-37693410
ABSTRACT
Objective:
Postpartum women can develop post-traumatic stress disorder (PTSD) in response to complicated, traumatic childbirth; prevalence of these events remains high in the U.S. Currently, there is no recommended treatment approach in routine peripartum care for preventing maternal childbirth-related PTSD (CB-PTSD) and lessening its severity. Here, we provide a systematic review of available clinical trials testing interventions for the prevention and indication of CB-PTSD. Data Sources We conducted a systematic review of PsycInfo, PsycArticles, PubMed (MEDLINE), ClinicalTrials.gov, CINAHL, ProQuest, Sociological Abstracts, Google Scholar, Embase, Web of Science, ScienceDirect, and Scopus through December 2022 to identify clinical trials involving CB-PTSD prevention and treatment. Study Eligibility Criteria Trials were included if they were interventional, evaluated CB-PTSD preventive strategies or treatments, and reported outcomes assessing CB-PTSD symptoms. Duplicate studies, case reports, protocols, active clinical trials, and studies of CB-PTSD following stillbirth were excluded. Study Appraisal and SynthesisMethods:
Two independent coders evaluated trials using a modified Downs and Black methodological quality assessment checklist. Sample characteristics and related intervention information were extracted via an Excel-based form.Results:
A total of 33 studies, including 25 randomized controlled trials (RCTs) and 8 non-RCTs, were included. Trial quality ranged from Poor to Excellent. Trials tested psychological therapies most often delivered as secondary prevention against CB-PTSD onset (n=21); some examined primary (n=3) and tertiary (n=9) therapies. Positive treatment effects were found for early interventions employing conventional trauma-focused therapies, psychological counseling, and mother-infant dyadic focused strategies. Therapies' utility to aid women with severe acute traumatic stress symptoms or reduce incidence of CB-PTSD diagnosis is unclear, as is whether they are effective as tertiary intervention. Educational birth plan-focused interventions during pregnancy may improve maternal health outcomes, but studies remain scarce.Conclusions:
An array of early psychological therapies delivered in response to traumatic childbirth, rather than universally, in the first postpartum days and weeks, may potentially buffer CB-PTSD development. Rather than one treatment being suitable for all, effective therapy should consider individual-specific factors. As additional RCTs generate critical information and guide recommendations for first-line preventive treatments for CB-PTSD, the psychiatric consequences associated with traumatic childbirth could be lessened.
Antepartum Education; Cesarean Section; Childbirth Trauma; Childbirth-related Post-Traumatic Stress Disorder (CB-PTSD); Delivery; Eye Movement Desensitization and Reprocessing (EMDR); Maternal Morbidity; Maternal Near-Miss; Maternal-Infant Attachment; Obstetric Complications; Obstetrics; Post-traumatic Stress Disorder (PTSD); Postpartum Period; Preterm; Psychological Counseling; Psychological Debriefing; Psychological Intervention; Skin to Skin; Trauma-Focused Cognitive Behavioral Therapy; Trauma-Focused Expressive Writing
Texto completo:
1
Base de dados:
MEDLINE
Tipo de estudo:
Clinical_trials
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Idioma:
En
Revista:
MedRxiv
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos