From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women

Abstract

Background: Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood.

Methods: Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum.

Results: Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period.

Limitations: Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed.

Conclusions: Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.

Keywords: Mixture modeling; Postpartum; Postpartum depression; Posttraumatic stress disorder (PTSD); Pregnancy.

Figure 1. Two-class solution during pregnancy suggesting homogenous symptom presentation at high versus low levels

Note. NACM = negative alterations in cognition and mood. To facilitate comparisons across symptom dimensions composed of different numbers of items and varying ranges, class means were Z-scored using the means and standard deviations for each variable during pregnancy.

Figure 2:. Five-class solution demonstrating heterogenous symptom presentation at 1-month postpartum

Note. NACM = negative alterations in cognition and mood. To facilitate comparisons across symptom dimensions composed of different numbers of items and varying ranges, class means were Z-scored using the means and standard deviations for each variable at 1-month postpartum.

Figure 3:. Three-class solution demonstrating heterogenous symptom presentation at 3-months postpartum

Note. NACM = negative alterations in cognition and mood. To facilitate comparisons across symptom dimensions composed of different numbers of items and varying ranges, class means were Z-scored using the means and standard deviations for each variable at 3-months postpartum.