BACKGROUND/OBJECTIVE: This study investigates factors associated with long-term posttraumatic stress following later termination of pregnancy due to fetal anomaly. METHODS: N = 159 women undergoing later termination of pregnancy were assessed at four time points: pre-termination (T0), at four months (T1, N = 115), one year (T2, N = 99), and four years post-termination (T3, N = 90). Participants answered a questionnaire containing questions about posttraumatic stress (IES), optimism (LOT-R), social support (F-SozU) and several sociodemographic as well as pregnancy related variables. To assess changes in posttraumatic stress over time and possible predictors, generalized estimating equations were calculated. RESULTS: Average posttraumatic stress declined significantly from T1 (52.3% above average) to T2 (20.0%) and T3 (17.8%). Optimism at T0 was a significant predictor for lower overall posttraumatic stress, avoidance and intrusion. Having previous children and higher gestational age were significant predictors for higher intrusion scores. CONCLUSIONS: Findings align with research indicating that most women recover from the initial distress, though some experience prolonged symptoms and should thus receive adequate psychological support. Lower optimism, having previous children and higher gestational age may be risk factors for higher posttraumatic stress levels. Further research should examine the sources of posttraumatic stress among people seeking abortion later in pregnancy due to fetal anomaly.