The perinatal period (pregnancy and the first 12 months postpartum) can be a vulnerable time to experience new traumatic experiences, such as life-threatening pregnancy complications or traumatic birth experiences (Grekin and O'Hara, 2014). Pregnancy, labor & delivery, and the early postpartum period can also be extremely stressful or retraumatizing for individuals with past trauma histories, especially for individuals with a prior reproductive or interpersonal trauma history (Seng et al., 2010; Banyard et al., 2001). Perinatal individuals are at heightened risk for new onset or exacerbation of existing posttraumatic stress disorder (PTSD) symptoms, a serious mental illness that may occur following exposure to a traumatic event (Berman et al., 2021; Grekin and O'Hara, 2014; Heyne et al., 2022). PTSD is characterized by four key symptom clusters: (1) re-experiencing intrusive thoughts, memories, and/or dreams of the event; (2) avoidance of internal and external trauma-related stimuli; (3) negative alterations in cognition and mood, including changes in how an individual feels about themselves, others, or the world; and (4) increased arousal, often in the form of hypervigilance or sleep/concentration difficulties (American Psychiatric Association, 2013). Perinatal PTSD symptoms can cause significant distress and impairment, regardless of if symptoms are new or pre-existing before the perinatal period (Cook et al., 2019; Stevens et al., 2021). Prevalence rates of perinatal PTSD range from 3 to 4 % in community samples (Grekin and O'Hara, 2014; Yildiz et al., 2017) and greatly increase (up to 30 %) among high-risk samples (Michopoulos et al., 2015; Seng et al., 2009, Seng et al., 2010, & Seng et al., 2011a,Seng et al., 2011b). Individuals with perinatal PTSD are at increased risk for the poorest maternal and infant outcomes, including pre-eclampsia, gestational diabetes, preterm birth, and increased likelihood of maternal and infant mortality (Shaw et al., 2017; Seng et al., 2001, Seng et al., 2011a,Seng et al., 2011b; Yildiz et al., 2017; Yonkers et al., 2014). Further, maternal exposure to trauma during pregnancy has long been associated with later child development (Moog et al., 2016; Ping et al., 2015).

Despite elevated risk for perinatal PTSD, limited attention has been paid to the various ways that PTSD symptoms can manifest during this high-risk period. This is in contrast to several studies that have collapsed across symptom clusters and examined overall symptom severity over time at similar time points as the current study (e.g., pregnancy (28 and 35 weeks) and the early postpartum period (4–6 weeks); Dikmen-Yildiz et al., 2018; Malaju and Alene, 2022; Muzik et al., 2016; Paulson et al., 2023). Because of the unique nature of pregnancy and childbirth—including biological and hormonal shifts and risk for difficult birthing experiences that can trigger new or exacerbate preexisting trauma-related distress (American College of Obstetricians and Gynecologists' Committee on Health Care for Underserved Women, 2021; Ayers et al., 2016; Seng et al., 2009) —it is unclear whether trauma-exposed women experience elevations across all symptom clusters or if some women experience meaningful elevations in a subset of symptom dimensions. The potential for symptom presentation to vary across pregnancy and the early postpartum period (i.e., 1- vs. 3-months postpartum) is also uncertain and requires exploration using advanced analytic techniques (e.g., mixture modeling).

Further, given high rates of comorbidity between PTSD and depression (Dindo et al., 2017; Padin et al., 2022), as well as overlap in diagnostic criteria, it is essential to understand whether symptoms unique to PTSD routinely co-occur with core features of depression or represent a distinct subclass of symptoms for some women. This diagnostic confusion has the potential to undermine access to adequate treatment through ineffective screening and referral. Research over the past decade has suggested that only two symptom clusters are specific to PTSD – intrusions and avoidance (Gootzeit and Markon, 2011). In contrast, the remaining symptom clusters – negative alterations in cognition and mood and hyperarousal – appear to be general, rather than specific, factors (Gootzeit and Markon, 2011; Watson and O'Hara, 2017) that reflect core features of depression (along with other symptoms such as lassitude). This has led psychopathology researchers to speculate that the comorbidity between PTSD and depression may reflect an underlying general distress captured by these overlapping symptom dimensions (Byllesby et al., 2017). As such, it is unclear to what degree PTSD symptom elevations observed across the perinatal period are largely reflecting general distress comorbid with depression or specific, trauma-related distress in the form of traumatic intrusions. Considering that current perinatal screening efforts focus almost exclusively on depression, clinicians may overlook the potential for women to experience symptoms unique to PTSD, such as intrusive thoughts and avoidance, that affect not only maternal well-being, but also parenting (Brockman et al., 2016; Laifer et al., 2021; Van Ee et al., 2016) and child outcomes (Bosquet Enlow et al., 2011; Lambert et al., 2014).

The Present Study.

There is a significant gap in knowledge regarding the nature of PTSD symptoms across pregnancy and postpartum. Specifically, it is unclear whether (a) trauma-exposed women experience elevations across all PTSD symptom clusters or if some women experience meaningful elevations in a subset of symptom dimensions, (b) symptom presentation varies across the perinatal period (e.g., pregnancy versus postpartum), and (c) symptoms unique to PTSD (e.g., traumatic intrusions and avoidance) routinely co-occur with core features of depression (e.g., alterations in cognition and mood, lassitude, appetite change). Further, most work on perinatal PTSD has focused on clinical samples, even though community samples can have high numbers of trauma-exposed women who experience significant distress and impairment (Dekel et al., 2017; Dikmen-Yildiz et al., 2018; Heyne et al., 2022).

The current study aimed to fill these gaps by applying mixture modeling to identify distinct profiles of PTSD and depressive symptoms during pregnancy, 1-month, and 3-months postpartum in a large community sample of trauma-exposed perinatal women (total N = 614, with over a third of participants completing measures across all three time points; data integrated from three longitudinal studies conducted between 2010 and 2017). Clinically, the 1-month time point was chosen as it coincides with typical timing of a postpartum checkup (4–6 weeks) and when perinatal individuals would be eligible to be diagnosed with MDD with peripartum onset (pregnancy and first four weeks postpartum; American Psychiatric Association, 2013). The 3-month time point was chosen to understand how symptoms may change as individuals reach the end of the vulnerable early postpartum period. Further, perinatal individuals often do not have care scheduled after the 4–6-week checkup. Thus, it is particularly important to understand how symptoms manifest given that other providers (i.e., pediatricians) may be in a better position to recognize/screen for psychopathology following the 1-month postpartum visit (Earls et al., 2019). Additionally, potential predictors of symptom profiles were examined including: (1) type of trauma (interpersonal trauma (MacKinnon et al., 2018) and reproductive trauma (Daugirdaitė et al., 2015)), (2) maternal age, and (3) minoritized racial/ethnic identity (Charuvastra and Cloitre, 2009; Farren et al., 2016; Muzik et al., 2016; Seng et al., 2011a,Seng et al., 2011b).