Psychological trauma associated with the World Trade Center attacks and its effect on pregnancy outcome

Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Paediatric and Perinatal Epidemiology (Impact Factor: 3.13). 10/2005; 19(5):334-41. DOI: 10.1111/j.1365-3016.2005.00676.x
Source: PubMed


The destruction of the World Trade Center (WTC) on 11 September 2001 was a source of enormous psychological trauma that may have consequences for the health of pregnant women and their fetuses. In this report, we describe the impact of extreme trauma on the birth outcomes of women highly exposed to the WTC. We enrolled 187 women who were pregnant and living or working within close proximity to the WTC on 11 September. Among women with singleton pregnancies, 52 completed at least one psychological assessment prior to delivery. In adjusted multivariable models, both post-traumatic stress symptomatology (PTSS) and moderate depression were associated with longer gestational durations, although only PTSS was associated with decrements in infant head circumference at birth (beta=-0.07, SE=0.03, P=0.01). The impact of stress resulting from extreme trauma may be different from that which results from ordinary life experiences, particularly with respect to cortisol production. As prenatal PTSS was associated with decrements in head circumference, this may influence subsequent neurocognitive development. Long-term follow-up of infants exposed to extreme trauma in utero is needed to evaluate the persistence of these effects.

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    • "Preliminary research shows that children are impacted even before birth by trauma that is experienced by their mothers. Studies in New York City comparing pregnant women who were close to Twin Towers on September 11 and suffered ''post traumatic stress syndrome'' (PTSS) with pregnant women who were in different locations, found that newborns of mothers manifesting PTSS had significant smaller head circumference at birth (Engel et al. 2005). As we know, decrements in head circumference influence subsequent neurocognitive development. "
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    ABSTRACT: This paper provides an overview of common traumatic events and responses, with a specific focus on the life cycle. It identifies selected “large T” and “micro” traumas encountered during childhood, adulthood and late life, and the concept of resilience. It also identifies the differences in traumatic events and reactions experienced by men compared to women, those related to the experience of immigration, and cross generational transmission of trauma. Descriptions of empirically-supported treatment approaches of traumatized individuals at the different stages of the life cycle are offered.
    Clinical Social Work Journal 12/2014; 42(4). DOI:10.1007/s10615-014-0496-z · 0.27 Impact Factor
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    • "Extensive qualitative research and case studies since the 1990s indicate that there are numerous psychosexual triggers that result in PTSD reactions from the pregnancy itself (e.g., fetal movement, fear of birth) and from intrusive medical procedures (Beck, 2004; Menage, 1993; Seng, Low, Sperlich, Ronis, & Liberzon, 2009; Seng, Sparbel, and PTSD are well documented (Yehuda, Halligan, & Grossman, 2001; Zajac & Kobak, 2009). Less is known about the effects of PTSD on obstetric and neonatal outcomes, but there is some evidence that it contributes to risk for maternal infection (Lev-Wiesel, Chen, Daphna-Tekoah, & Hod, 2009), low birth weight and preterm birth (Rogal et al., 2007; Rosen, Seng, Tolman, & Mallinger, 2007), a higher number of complications during pregnancy (Möhler et al., 2008), and decrements in the newborn's neurolinguistic development (Engel, Berkowitz, Wolff, & Yehuda 2005; Enlow et al., 2009; Field et al., 2006; Laplante, Brunet, Schmitz, Ciampi, & King, 2008). Therefore, trauma-informed interventions aimed at addressing the posttraumatic sequelae of childhood maltreatment and sexual traumas have the potential to benefit both the woman and her child. "
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    ABSTRACT: Pregnant women with history of abuse and posttraumatic stress disorder (PTSD) have increased risk of adverse mental health and childbearing outcomes. The Survivor Moms' Companion (SMC) is a psychoeducation program designed to meet the needs of women abuse survivors affected by PTSD during the childbearing year. This article reports on the feasibility, safety, and acceptability findings of an open pilot. Participants completed 10 self-study modules and structured tutoring sessions, and completed self-report measures, including reports of tutor fidelity to the manual, repeated assessment of PTSD symptoms, Subjective Units of Disturbance (SUD) scores, and evaluation interviews. Results indicate that the intervention can be implemented within low-resource settings with high level of fidelity to the manual. Monitoring of PTSD symptom level and distress indicate that the intervention is safe. Participants report satisfaction with the format and content and appreciation for the tutoring component. The SMC appears to be feasible, safe, and acceptable.
    05/2011; 1(2):122-135. DOI:10.1891/2156-5287.1.2.122
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    • "PTSD is associated with physical comorbidity in women across the lifespan (Seng et al. 2006). It also has been associated with some pregnancy complications and with adverse outcomes in preliminary (Seng et al. 2001) and small-sample studies (King et al. 2005; Engel et al. 2005; Rosen et al. 2007). Our on-going study of the effects of PTSD on childbearing outcomes (NIH NR008767, PI Seng) found higher rates of current PTSD among the African American (AA) women, 13.4% versus 3.5% for non-African American (non-AA) women (Seng et al. 2009). "
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    ABSTRACT: To determine whether African American women expecting their first infant carry a disproportionate burden of posttraumatic stress disorder morbidity, we conducted a comparative analysis of cross-sectional data from the initial psychiatric interview in a prospective cohort study of posttraumatic stress disorder effects on childbearing outcomes. Participants were recruited from maternity clinics in three health systems in the Midwestern USA. Eligibility criteria were being 18 years or older, able to speak English, expecting a first infant, and less than 28 weeks gestation. Telephone interview data was collected from 1,581 women prior to 28 weeks gestation; four declined to answer racial identity items (n = 1,577), 709 women self-identified as African American, 868 women did not. Measures included the Life Stressor Checklist, the National Women's Study Posttraumatic Stress Disorder Module, the Composite International Diagnostic Interview, and the Centers for Disease Control's Perinatal Risk Assessment Monitoring System survey. The 709 African American pregnant women had more trauma exposure, posttraumatic stress disorder symptoms and diagnosis, comorbidity and pregnancy substance use, and had less mental health treatment than 868 non-African Americans. Lifetime prevalence was 24.0% versus 17.1%, respectively (OR = 1.5, p = 0.001). Current prevalence was 13.4% versus 3.5% (OR = 4.3, p < 0.001). Current prevalence of posttraumatic stress disorder (PTSD) was four times higher among African American women. Their risk for PTSD did not differ by sociodemographic status, but was explained by greater trauma exposure. Traumatic stress may be an additional, addressable stress factor in birth outcome disparities.
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