Objective To describe the implementation and outcomes of an Eye Movement and Desensitisation Reprocessing (EMDR)-treatment-program for women with Posttraumatic stress disorder (PTSD) after childbirth. Design Prospective cohort-study with pre- and post measurements. Setting A large university hospital in the Netherlands. Population Women who gave birth to a living child at least 4 weeks ago, with a PTSD diagnosis, or severe PTSD-symptoms combined with another DSM-5 diagnosis, who provided written informed consent. Methods The intervention applied was EMDR, an evidence-based psychotherapy for patients with PTSD. Main Outcome Measures The PTSD Checklist for DSM-5 (PCL-5) was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5 (LEC-5), the Childhood Trauma Questionnaire (CTQ-SF) and the Childbirth Perception Scale (CPS). Results Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD anymore after on average 5 weekly sessions of EMDR-treatment. These outcomes are extra promising, as they were achieved in quite a complex group of women with relatively high psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%). Conclusions Implementing an EMDR-therapy treatment program for women with after childbirth PTSD in the context of a large academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualisation addressing the aetiology of the PTSD. Funding No external funding. Keywords Posttraumatic Stress Disorder after childbirth, EMDR-therapy, Psychiatry, Implementation.

Objective: Congenital cardiac outflow defects (COD) are the largest group of congenital heart defects, with ventricular septal defect (VSD) as the most prevalent phenotype. Increased maternal age, excessive oxidative stress and inflammation are involved in the pathophysiology and enhance telomere length (TL) shortening. We aim to study the association between periconception maternal TL, as future predictive biomarker, and the risk of having a child with COD. Design: HAVEN-study, a multicenter case-control triad study conducted in the Netherlands. Setting and population: 306 case mothers of a child with COD and 424 control mothers of a child without a congenital malformation were selected. Methods: TL was estimated, on DNA from venous blood samples, by qPCR. Multivariable logistic regression was used to compute crude and adjusted odds ratios (OR) per standard deviation (SD) decrease between maternal T/S ratio and COD and VSD risk. Main outcome measures: The risk of COD in offspring. Results: A significant association was shown between maternal TL shortening (per standard deviation) and a 29% increased risk of VSD in offspring (OR 1.29(95% CI 1.04-1.61), P= 0,02), which remained significant after additional adjustment for maternal age (adjOR 1.25(95% CI 1.01-1.55), P= 0,04). No association between maternal TL and the risk of overall COD in offspring was observed. Conclusion: Shortening of maternal TL, due to maternal conditions including age, is associated with an approximately 1.3-fold increased risk, per SD in TL-shortening, of VSD in the offspring. These findings need further confirmation in other studies on the predictive value of maternal TL.