This multicenter prospective cohort study (ancillary to the TRAAP trial, 15 French university hospitals, 2015–2016) characterized posttraumatic stress symptom (PSS) trajectories from day 2 to 2 months postpartum in women with term vaginal deliveries (≥35 weeks), and identified risk factors for each trajectory using multivariable logistic regression.
Among 3,891 women, corrected prevalences were: 83.4% asymptomatic, 11.0% recovered, 2.1% emerging, and 3.5% persistent — meaning ~1 in 20 had an unfavorable PSS trajectory. Persistent symptoms (vs. recovery) were linked to younger age, non-European origin (aOR 1.8), psychiatric history (aOR 1.9), bad delivery memories (aOR 2.4), and postpartum hemoglobin <9 g/dL (aOR 1.8). Emerging symptoms were associated with prior abortion (aOR 2.6), antenatal hospitalization (aOR 2.8), labor induction (aOR 1.7), bad delivery memories (aOR 3.7), and day-2 fatigue (aOR 2.2); epidural analgesia was protective (aOR 0.2).
- Only 60.2% of enrolled women completed IES-R at both time points, introducing potential nonresponse bias (partially addressed by inverse probability weighting). - The IES-R is a symptom screener, not a diagnostic tool for PTSD, so true PTSD prevalence may differ. - Data were collected from 2015–2016 in French university hospitals, limiting generalizability to other settings or care models.
Screen women after vaginal delivery for PSS risk using identifiable factors at day 2: poor delivery memories, postpartum anemia (Hb <9 g/dL), psychiatric history, and day-2 fatigue. Epidural analgesia may reduce the risk of emerging PSS and warrants consideration as part of a broader trauma-informed birth care strategy.
