Posttraumatic stress symptoms following childbirth: associations with prenatal attachment in subsequent pregnancies

  • Susan Garthus-NiegelEmail author
  • Antje Horsch
  • Tilmann von Soest
  • Silje Marie Haga
  • Filip Drozd
  • Susan Ayers
  • Malin Eberhard-Gran
Original Article


This longitudinal population-based study aimed to investigate the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy. Data were derived from the Norwegian Akershus Birth Cohort (ABC), a large population-based prospective cohort study. Data from 1473 women who had given birth at least once before and who had completed questionnaires at 17 and 32 weeks of gestation were included. Confirmatory factor analysis of the short version of the Prenatal Attachment Inventory was conducted to validate the scale. Further, structural equation modeling techniques were used to estimate prospective associations of PTSD symptoms following childbirth with prenatal attachment. Finally, to explore potential mechanisms of the association, mediation and moderation analyses were conducted. PTSD symptoms following previous childbirth were found to be prospectively related to higher levels of prenatal attachment in the subsequent pregnancy, while controlling for important confounding factors, such as symptoms of maternal depression and anxiety, previous pregnancy loss, and sociodemographic factors (maternal age, educational level, marital status, and number of children). When fear of childbirth was included as a potential mediating variable, the prospective relationship between PTSD symptoms following childbirth and prenatal attachment in the subsequent pregnancy increased, thereby indicating a suppressor effect. Fear of childbirth did not act as a significant moderator. Our findings suggest that a subsequent pregnancy following a traumatic childbirth may for some women represent an opportunity for a higher level of prenatal attachment, whereas high levels of fear of childbirth may be detrimental for prenatal attachment.


Posttraumatic stress disorder PTSD following childbirth Prenatal attachment Fear of childbirth Akershus Birth Cohort 


Funding information

Supported by the Norwegian Research Council (project no. 191098), and a project grant from the Swiss National Science Foundation (grant number 32003B_172982/1 [to AH]).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Susan Garthus-Niegel
    • 1
    • 2
    Email author
  • Antje Horsch
    • 3
    • 4
  • Tilmann von Soest
    • 5
  • Silje Marie Haga
    • 6
  • Filip Drozd
    • 6
  • Susan Ayers
    • 7
  • Malin Eberhard-Gran
    • 6
    • 8
    • 9
  1. 1.Department of Psychotherapy and Psychosomatic MedicineFaculty of Medicine of the Technische Universität DresdenDresdenGermany
  2. 2.Department of Child Health and DevelopmentNorwegian Institute of Public HealthOsloNorway
  3. 3.Institute of Higher Education and Research in Healthcare (IUFRS)Lausanne University and Lausanne University HospitalLausanneSwitzerland
  4. 4.Department Woman-Mother-ChildLausanne University HospitalLausanneSwitzerland
  5. 5.PROMENTA Research Center, Department of PsychologyUniversity of OsloOsloNorway
  6. 6.Department for Infant Mental HealthRegional Centre for Child and Adolescent Mental Health, Eastern and Southern NorwayOsloNorway
  7. 7.Centre for Maternal and Child Health Research, School of Health SciencesCity, University of LondonLondonUK
  8. 8.HØKH, Research CentreAkershus University HospitalAkershusNorway
  9. 9.Institute of Clinical Medicine, Campus AhusUniversity of OsloLørenskogNorway

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