Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study

Background: Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition. Objective: We investigated the prevalence and risk factors for maternal trauma and...

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Main Authors: Nastassja Koen, Kirsty Brittain, Kirsten A. Donald, Whitney Barnett, Sheri Koopowitz, Karen Maré, Heather J. Zar, Dan J. Stein
Format: Article
Language:English
Published: Taylor & Francis Group 2016-02-01
Series:European Journal of Psychotraumatology
Subjects:
Online Access:http://www.ejpt.net/index.php/ejpt/article/view/28720/pdf_133
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spelling doaj-fe7b361db76743a890c8d423cabb229e2020-11-25T02:38:52ZengTaylor & Francis GroupEuropean Journal of Psychotraumatology2000-80662016-02-017011310.3402/ejpt.v7.2872028720Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health StudyNastassja Koen0Kirsty Brittain1Kirsten A. Donald2Whitney Barnett3Sheri Koopowitz4Karen Maré5Heather J. Zar6Dan J. Stein7 Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South AfricaBackground: Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition. Objective: We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study. Methods: Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES), and depression. Results: A total of 544 mother–infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV). The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction (95% CI: 0.1; 0.5) in infant head-circumference-for-age z-scores (HCAZ scores) at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model. Conclusions: In this exploratory study, maternal trauma and PTSD were found to be highly prevalent, and preliminary evidence suggested that trauma may adversely affect fetal growth, as measured by birth head circumference. However, these findings are limited by a number of methodological weaknesses, and further studies are required to extend findings and delineate causal links and mechanisms of association.http://www.ejpt.net/index.php/ejpt/article/view/28720/pdf_133TraumaPTSDpregnancyintergenerationalbirth cohortbirth outcomesSouth Africa
collection DOAJ
language English
format Article
sources DOAJ
author Nastassja Koen
Kirsty Brittain
Kirsten A. Donald
Whitney Barnett
Sheri Koopowitz
Karen Maré
Heather J. Zar
Dan J. Stein
spellingShingle Nastassja Koen
Kirsty Brittain
Kirsten A. Donald
Whitney Barnett
Sheri Koopowitz
Karen Maré
Heather J. Zar
Dan J. Stein
Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
European Journal of Psychotraumatology
Trauma
PTSD
pregnancy
intergenerational
birth cohort
birth outcomes
South Africa
author_facet Nastassja Koen
Kirsty Brittain
Kirsten A. Donald
Whitney Barnett
Sheri Koopowitz
Karen Maré
Heather J. Zar
Dan J. Stein
author_sort Nastassja Koen
title Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
title_short Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
title_full Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
title_fullStr Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
title_full_unstemmed Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study
title_sort psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the drakenstein child health study
publisher Taylor & Francis Group
series European Journal of Psychotraumatology
issn 2000-8066
publishDate 2016-02-01
description Background: Prenatal and peripartum trauma may be associated with poor maternal–fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition. Objective: We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study. Methods: Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES), and depression. Results: A total of 544 mother–infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV). The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction (95% CI: 0.1; 0.5) in infant head-circumference-for-age z-scores (HCAZ scores) at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model. Conclusions: In this exploratory study, maternal trauma and PTSD were found to be highly prevalent, and preliminary evidence suggested that trauma may adversely affect fetal growth, as measured by birth head circumference. However, these findings are limited by a number of methodological weaknesses, and further studies are required to extend findings and delineate causal links and mechanisms of association.
topic Trauma
PTSD
pregnancy
intergenerational
birth cohort
birth outcomes
South Africa
url http://www.ejpt.net/index.php/ejpt/article/view/28720/pdf_133
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