Joint prenatal depression-anxiety trajectories are associated with childbirth-related posttraumatic stress symptoms: a prospective cohort study

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Latent class growth analysis identified two joint prenatal depression and anxiety trajectories: low symptoms (88.0%) and high symptoms (12.0%).
Women in the high-symptom trajectory had significantly higher childbirth-related posttraumatic stress symptom scores postpartum (B=5.14, β=0.278, 95% CI 3.84 to 6.44, P<0.001).
Prenatal joint symptom trajectories may help identify women who could benefit from additional psychological support during pregnancy; sensitivity analyses replicated findings.

Midwifery. 2026 Nov 1;164:105033. doi: 10.1016/j.midw.2026.105033. Online ahead of print.

ABSTRACT

BACKGROUND: Prenatal depression and anxiety frequently co-occur and are recognised risk factors for childbirth-related posttraumatic stress symptoms. Although these psychological symptoms change across pregnancy, it remains unclear whether their joint developmental trajectories are associated with subsequent childbirth-related posttraumatic stress symptoms.

METHODS: This prospective cohort study recruited 1123 pregnant women from a tertiary hospital, of whom 735 were included in the final analysis. Depressive and anxiety symptoms were assessed during early, middle, and late pregnancy using the Patient Health Questionnaire-9 and the generalised Anxiety Disorder-7. Latent class growth analysis was used to identify joint symptom trajectories. Childbirth-related posttraumatic stress symptoms were assessed 6-12 weeks postpartum using the City Birth Trauma Scale. Multivariable linear regression analyses examined the associations between trajectory membership and childbirth-related posttraumatic stress symptoms after adjustment for sociodemographic and obstetric characteristics. Sensitivity analyses were performed using the Edinburgh Postnatal Depression Scale.

RESULTS: A two-class solution provided the best model fit, comprising a low-symptom trajectory (88.0%) and a high-symptom trajectory (12.0%). After adjustment for potential confounders, women in the high-symptom trajectory reported significantly higher childbirth-related posttraumatic stress symptom scores than those in the low-symptom trajectory (B = 5.14, β = 0.278, 95% CI 3.84-6.44, P < 0.001). Sensitivity analyses using the Edinburgh Postnatal Depression Scale yielded comparable findings.

CONCLUSIONS: Distinct joint trajectories of prenatal depression and anxiety were associated with subsequent childbirth-related posttraumatic stress symptoms. Prenatal psychological symptom patterns may help identify women who could benefit from additional psychological support during pregnancy.

PMID:42987687 | DOI:10.1016/j.midw.2026.105033

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