Displacement and associated factors of childbirth-related posttraumatic stress disorder among Ukrainian perinatal women

Abstract

Background: The ongoing war in Ukraine has profoundly disrupted maternal healthcare and exposed women to acute psychosocial stressors throughout the perinatal period. This context may heighten the risk of childbirth-related posttraumatic stress disorder (CB-PTSD), particularly among displaced women. Objective: To identify and compare the proportion of women meeting full diagnostic criteria for CB-PTSD and the severity of specific symptom clusters (stressor, re-experiencing, avoidance, negative cognitions and mood, hyperarousal, distress, and dissociation) by displacement status, and to examine sociodemographic, obstetric, and war-related psychosocial factors associated with CB-PTSD. Method: Data came from an online survey of 318 Ukrainian perinatal women grouped as not displaced (ND), internally displaced (ID), or externally displaced (ED). Measures included CB-PTSD (City BiTS), assessment, care, and trust in pregnant and new mothers (ACT-PNM), and emotional stability (TIPI). Group differences in CB-PTSD diagnostic status and symptom clusters were analysed using Pearson’s chi-square tests, Welch one-way ANOVAs, Spearman correlations and Kruskal–Wallis tests. Hierarchical linear regression models assessed the contribution of sociodemographic, obstetric, and war-related psychosocial factors to CB-PTSD symptom severity. Results: Overall, 4.9% of women met full diagnostic criteria for CB-PTSD, with a tendency to higher rates across displacement groups (9.4% ND vs. 8.3% ED). Symptom differences by displacement status were only significant for the dissociation cluster, which were elevated among displaced women, while other clusters did not differ across groups. Factors significantly associated with higher CB-PTSD scores included neonatal intensive care unit admission, lack of resources across key domains since the onset of the war, worsened perinatal care, high financial stress due to the war, greater war-related disruption in daily life, and lower emotional stability, jointly explaining 37.1% of the variance in CB-PTSD. Conclusions: Ukrainian women giving birth during wartime face pronounced psychosocial vulnerability, particularly when displaced. These findings highlight the urgent need for trauma-informed perinatal care and targeted psychosocial support tailored to conflict-affected perinatal populations.