Prevention and treatment of PTSD following childbirth: neurobiological perspectives

Background: Traumatic birth experiences may give rise to PTSD following childbirth (PTSD-FC). The perinatal period is associated with neurobiological alterations in HPA axis- and oxytocinergic systems also implicated in the response to trauma. However, little is known about neurobiological alterations in PTSD-FC and how these may play a role in the prevention and treatment of PTSD-FC. Recent research indicates a potential role for oxytocin. Aim and Objectives: To provide a synthesis of evidence on epidemiology, prevention, and treatment of PTSD-FC including neurobiological alterations and treatment-potential of hormones such as oxytocin. Method: Literature searches were performed in PubMed, Psychinfo, and Web of Science. Results: The prevalence for PTSD-FC ranges from 3-4% in community samples to up to 19% in high risk samples. Clinical trials in the treatment or prevention of PTSD-FC are scarce and do not include neurobiological alterations but the related domains of PTSD and the perinatal period provide findings relevant for PTSD-FC. A systematic search for exogenous oxytocin trials in women with PTSD-FC generated no findings. However, direct neurobiological and psychological effects of oxytocin were positive in trials with PTSD patients albeit negative in trauma-exposed individuals. In postpartum women an oxytocin-related increase of neural processing in reward-related areas was found as well as improved therapist- and infant relationships in women with postpartum depression although their mood worsened. Interpretation: Knowledge of epidemiological factors of PTSD-FC is adequate but research of treatment and prevention of PTSD-FC is scarce and lacks neurobiological data. Exogenous oxytocin has not been studied in PTSD-FC but treatment-relevant neurobiological and psychological changes have been found in PTSD and postpartum depression although negative oxytocin findings should also be acknowledged. Conclusions: This review provides recommendations and cautionary notes for future research into the neurobiological aspects of preventing and treating PTSD-FC.