Associations between Past Sexual Victimization and Perinatal PTSD: A Systematic Review and Meta-Analysis

Background: The birth of a new baby is a transformative event in a woman’s life, often regarded as a joyful and fulfilling experience. However, for women who are survivors of sexual victimization, the perinatal period can be perceived as a reenactment of abuse leading to post-traumatic stress disorder (PTSD). Survivors report a multitude of triggers during the perinatal period, as the same parts of a woman’s body that were violated in the past are also necessary to perform cervical checks, have a vaginal delivery, and breastfeed an infant. Experiences of past sexual victimization have important implications for optimizing perinatal care for mothers. Indeed, the American College of Obstetricians and Gynecologist recommends that all women be screened for a history of sexual victimization. However, the low reported rates of sexual victimization among women receiving perinatal care indicates this risk factor is often under identified. A robust synthesis of the literature assessing a link between past sexual victimization and the presence or absence of PTSD could bolster the case for implementing improved screening practices and trauma-informed obstetric care.

Methods: A protocol was adapted from Cochrane Collaboration guidelines and other expert resources (i.e., Campbell Collection, PRISMA and AMSTAR standards) to develop a priori inclusion/exclusion criteria and conduct a systematic review of English language literature. Inclusion criteria for relevant studies were (a) an explicit focus on past sexual victimization, (b) a measure of PTSD between conception and one-year postpartum, and (c) sufficient quantitative data to enable calculation of effect sizes assessing the association between sexual victimization and PTSD. Four bibliographic databases were searched using predefined search strings developed with a social science reference librarian. Data from included studies were tabled and analyzed. Overall and subgroup pooled effect sizes were estimated.

Findings: Five hundred and twelve abstracts were identified for title/abstract review and 59 articles were selected for full text review. Thirteen articles met all inclusion criteria, resulting in 29 individual effect size estimates. Results from the meta-analysis of the overall effect size indicated a significant average effect size (OR=1.49, 95% CI [1.28, 1.70]), such that past sexual victimization was associated with a 49% increase in the odds that individuals would report experiencing PTSD during the perinatal period. Comparable average effect sizes were yielded from subgroup analyses conducted with respect to (a) the type of analysis conducted (i.e., bivariate versus multivariate), (b) the inclusion of various covariates (i.e., other forms of abuse, past depression), (c) timing of sexual victimization (i.e., childhood, adulthood), and (d) the PTSD measure used.

Conclusions/Implications: Survivors of past sexual victimization are at increased risk of developing PTSD during the perinatal period. This is in addition to other risks to psychiatric health including increased risk of perinatal depression. Results call for the attention of health care providers and social workers to determine how screening practices and trauma-informed obstetric care can be improved during the perinatal period for women who have experienced a history of sexual victimization. Further, results demonstrate a need for the implementation of effective interventions to serve this vulnerable population.