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BackgroundAdverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post‐traumatic stress disorder (PTSD) in women with ACEs is lacking.MethodsA systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random‐effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software.ResultsSeven studies were included in the system review. One study was identified as an outlier and excluded from the meta‐analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%–29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta‐regression to identify factors influencing study heterogeneity was not conducted.ConclusionThe incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women.
BackgroundAdverse childhood experiences (ACEs) are known contributors to lifelong mental health challenges. Despite studies linking ACEs to increased risk of adverse postpartum mental health outcomes, a systematic review on the occurrence of postpartum post‐traumatic stress disorder (PTSD) in women with ACEs is lacking.MethodsA systematic search was conducted in seven databases to retrieve studies from inception to January 31, 2024. A random‐effects model was used to quantify weighted estimates of postpartum PTSD incidence. Statistical analysis was conducted using R software.ResultsSeven studies were included in the system review. One study was identified as an outlier and excluded from the meta‐analysis. Among the six remaining studies, 1186 women exposed to ACEs were identified, with 249 of them experiencing postpartum PTSD. The estimated incidence of postpartum PTSD among women exposed to ACEs was 22.6% (95% confidence interval [CI] 16.1%–29.8%). Subgroup analysis revealed significant variations in incidence depending on study settings (p < 0.01) and PTSD assessment methods (p < 0.01). Due to multicollinearity among the primary variables, a meta‐regression to identify factors influencing study heterogeneity was not conducted.ConclusionThe incidence of postpartum PTSD was 22.6% in women with ACEs, higher than that observed in the general obstetric population. This finding suggests the need to provide comprehensive postpartum care for these women.
IntroductionActive‐duty servicewomen and veterans make up nearly 20% of the United States military and may experience trauma specific to military service. Military‐specific trauma includes combat deployment and military sexual trauma, exposure to which may result in posttraumatic stress disorder (PTSD). The purpose of this scoping review is to examine the extent to which military trauma exposures impact the pregnancy outcomes of active‐duty servicewomen and women veterans.MethodsA systematic search of OVID MEDLINE, OVID Embase, and OVID PsycINFO from inception to September 25, 2023, identified studies examining associations between military trauma exposures and perinatal outcomes. Of the 614 studies identified, 464 were reviewed for relevance, with 16 meeting inclusion criteria.ResultsOf the 16 included studies, 14 found associations between military trauma exposure and adverse pregnancy outcomes including preterm birth, gestational diabetes, hypertensive disorders of pregnancy, low birth weight, and perinatal mood and anxiety disorders. The risks of adverse pregnancy outcomes increased with the severity of PTSD, the recency of combat deployment, and repetitive deployment.DiscussionThis scoping review strengthens the link between trauma exposures and adverse pregnancy outcomes for current and former military servicewomen. A gap in the literature persists regarding trauma exposure among active‐duty servicewomen, which differs significantly from women veterans. As mental health conditions are the leading underlying cause of maternal mortality, standardized screening during the perinatal period for military‐specific trauma exposures and PTSD is recommended for this population. Black servicewomen of junior enlisted rank carry disproportionate burdens of PTSD diagnosis and adverse pregnancy outcomes. Comprehensive prenatal and postpartum management may improve perinatal and neonatal outcomes for military servicewomen and provide an innovative approach to reducing existing racial disparities.
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