From prematurity to parenting stress: the mediating role of PTSD

Objective Preterm delivery may represent a traumatic event for mothers that may lead to the emergence of post-traumatic stress disorder (PTSD). In turn, the persistence of PTSD symptoms may affect the quality of the mother-child relationship (Muller-Nix et al., 2004; Shah, Clements, & Poehlmann, 2011). The principal objective of this study is to shed light on the factors that determine the development of parenting stress in mothers of preterm and full-term children. Design The present study aims to examine perinatal PTSD and the levels of parenting stress in mothers of preterm and full-term children. This study proposes a mediating role of PTSD symptoms between preterm/full-term birth and levels of parenting stress. The sample included 156 mothers of full-term children and 87 mothers of preterm children (Gestational Age <37 weeks) aged 1 month to 3 years. The mothers were asked to complete a Web-survey assessing perinatal PTSD symptoms (PPQ), parenting stress (PSI-SF) and social support (MSPSS). Results The findings showed that mothers of preterm children experienced more post-traumatic and parenting stress than did mothers of term children. However, preterm birth itself had only an indirect influence on subsequent levels of parenting stress. This relationship was mediated by PTSD symptoms. Moreover, the child’s age moderated the association between maternal PTSD and parenting stress. Levels of PTSD symptoms in preterm mothers were higher for infants born at lower gestational age. Conclusions Our findings suggest that prematurity does not constitute the only risk factor for the emergence of parenting stress (Singer et al., 2010). A pivotal role seems to be played by the maternal perception of childbirth as a traumatic experience and by the subsequent development of PTSD. Implications for preventive interventions are addressed.