Current Diagnosis of PTSD is Risk Factor for Pregnant Women
BACKGROUND:
PTSD affects an estimated 1 in 20 reproductive-aged women, and is even more concentrated in pregnant Veterans who receive VA healthcare. Previous research shows that PTSD is associated with an increased risk of pre-term birth. The risk that PTSD poses for pregnancies beyond pre-term birth remains uncertain. Therefore, this retrospective cohort analysis evaluated the associations between PTSD and antepartum complications to explore how PTSD's pathophysiology impacts pregnancy in a large cohort of women Veterans. Of the 15,986 women Veterans who gave birth to a single child from 2000 to 2012, investigators identified 2,977 (19%) who had a PTSD diagnosis: 1,880 (12%) of whom had a current PTSD diagnosis, and 1,097 (7%) of whom had a history of PTSD. From hospital claims data, investigators extracted all diagnoses for delivery and antepartum/post-partum hospitalizations, defined as inpatient discharges within 34 weeks before and 6 weeks post-delivery. Investigators then estimated adjusted risk for the association of PTSD with five antepartum complications: gestational diabetes, preeclampsia, gestational hypertension, growth restriction, and abruption.
FINDINGS:
- A current diagnosis of PTSD increases the risk of hypertensive/ischaemic placental complications of pregnancy, specifically preeclampsia, and is a risk factor for gestational diabetes (GDM).
- PTSD also was associated with an increased risk of prolonged (>4 day) delivery hospitalization and repeat hospitalization.
- The most common antepartum complications observed were GDM (4.9%) and preeclampsia (4.6%), and the occurrence of caesarean delivery was 33%. However, PSTD was not associated with likelihood of caesarean delivery.
IMPLICATIONS:
- Pregnancies in women with currently active PTSD should be identified as potentially high-risk, high-need pregnancies. Clinicians and healthcare systems should work together to use the pre-conception and prenatal episode as an opportunity to engage women with PTSD in mental healthcare and evaluate whether coordinated and appropriate mental health treatment modifies the increased obstetric risk.
LIMITATIONS:
- Reliance on diagnostic codes from discharge claim data may have led to misclassification of obstetric outcomes.
- Investigators were unable to evaluate PTSD treatment, so could not comment on how this might modify the association with obstetric complications.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. J. Shaw, Asch, Kimerling, Frayne, and Phibbs are part of HSR&D's Center for Innovation to Implementation (Ci2i), Palo, Alto, CA. Dr. Katon is part of HSR&D's Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, and Dr. Katon is supported by an HSR&D Career Development Award (CDA 13-266).
Shaw J, Asch S, Katon J, Shaw K, Kimerling R, Frayne S, and Phibbs C. Post-traumatic Stress Disorder and Antepartum Complications: A Novel Risk Factor for Gestational Diabetes and Preeclampsia. Paediatric and Perinatal Epidemiology. May 2017;31(3):185-194
