Post-Traumatic Stress Disorder (PTSD)

INFORMATION FOR WOMEN WHO HAVE POST-TRAUMATIC STRESS DISORDER DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is post-traumatic stress disorder during pregnancy?

Post-traumatic stress disorder (PTSD) can develop if you have experienced a disturbing, dangerous, or scary event that connected your fear with memories of the event and with various sensations that may not be connected only with the event. If encountering those sensations triggers fear and anxiety at levels much greater than they normally should, this is characteristic of PTSD. While many people experience traumatic events, most such events do not lead to PTSD. Thus, the defining feature of PTSD is that otherwise normal stimuli can trigger memories of traumatic events and with those memories very strong negative feelings. Because your body undergoes many changes throughout pregnancy, it is possible that attacks of PTSD can be triggered while you are pregnant. Similarly, any traumatic experiences occurring in connection with pregnancy, such as suffering a miscarriage, potentially can lead to PTSD later on.

How common is PTSD during pregnancy?

The prevalence of PTSD during pregnancy reflects the prevalence of PTSD among women overall. The National Center for PTSD estimates that 7-8 percent of people will have PTSD at least once. Women have PTSD more than men, even though approximately 60 percent of men experience trauma at least once in life compared with approximately 50 percent of women. For pregnant women of racial minorities, teenagers who are pregnant, and those with lower educational status, the rate of PTSD during pregnancy has been reported to reach as high as 24 percent.

How is PTSD during pregnancy diagnosed?

PTSD is diagnosed based on the person meeting extensive criteria, namely:

  • The person was exposed to death, the threat of death, threatened or actual severe injury, or threatened or actual sexual violence. This may include being the threatened or injured person or being a witness, or responder to the event
  • The person re-experiences the event later on in the form of memories, nightmares, flashbacks, physical reenactment, or emotional distress
  • The person avoids stimuli that provoke the memories or flashbacks
  • Negative thoughts or feelings have worsened gradually after the traumatic event
  • Alterations in activity or arousal. This criterion includes things such as aggression and irritability, difficulty concentrating, over-responding to stimuli, and becoming easily startled
  • The symptoms must last for at least one month
  • The symptoms impair the persons functioning
  • The symptoms are not the result of medication, or substance abuse, or a medical condition

Does PTSD cause problems during pregnancy?

PTSD increases the chances that if you conceive, you will suffer a bad pregnancy, such as an ectopic pregnancy. PTSD causes you to be irritable, easily startled and scared, and to avoid anything that may remind you of the traumatic event. It interferes with your ability to sleep, and thus exacerbates the problems that many women already have sleeping while pregnant.

Does PTSD cause problems for the baby?

PTSD elevates the risk of spontaneous abortion (miscarriage), low birth weight, and preterm birth. It also may interfere with the development of the fetal brain and the system of hormones that connects the brain with the bodys response to stress. Researchers suspect that all of this may lead to problems with temperament, attention, mood, anxiety, and cognition in children of mothers with PTSD.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the PTSD
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat PTSD during pregnancy?

A range of medications is given to combat symptoms of PTSD, including the selective serotonin reuptake inhibitor (SSRI) antidepressants sertraline and paroxetine. While SSRIs are generally considered safe in pregnancy, paroxetine may slightly increase the risk of heart defects in the baby. Medications also include antianxiety drugs, many of which have a high potential for addiction, so decisions regarding whether to use them and which ones to use must not be taken lightly. It is best to have a psychiatrist as part of the team of physicians managing your case. A drug called prazosin, whose main use has been to treat high blood pressure, may be effective against nightmares in those with PTSD. Little is known about the safety of this drug, so it should be used only if it improves your condition greatly.

Who should NOT stop taking medication for PTSD during pregnancy?

Every case of PTSD is different, and the decision of whether to discontinue a particular drug should be made in consultation with your medical and mental health providers.

What should I know about choosing a medication for my PTSD during pregnancy?

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for my PTSD when I am breastfeeding?

Controversy surrounds the use of psychotropic medications during breastfeeding, although sertraline and paroxetine are not thought to be particularly risky in nursing mothers. Not much is known about the safety of prazosin in nursing mothers.

What alternative therapies besides medications can I use to treat my PTSD during pregnancy?

PTSD is treated with various specialized types of cognitive-behavioral therapy. These include cognitive processing therapy, prolonged exposure therapy, stress inoculation training, and eye movement desensitization and reprocessing.

What can I do for myself and my baby when I have PTSD during pregnancy?

Recognize your condition and be assured that treatment is available.

Resources for PTSD in pregnancy:

For more information about PTSD during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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