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Publication Briefs

Current Diagnosis of PTSD is Risk Factor for Pregnant Women

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.


  • 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.


  • 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.


  • 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.

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).

PubMed Logo 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

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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