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2015 HSR&D/QUERI National Conference Abstract

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1072 — PTSD and Antepartum Complications: Increased Risk of Gestational Diabetes and Preeclampsia

Shaw JG, VA Palo Alto & Stanford University; Asch SM, VA Palo Alto & Stanford University; Katon J, VA Puget Sound & Univesrity of Washington; Shaw KA, Stanford University; Kimerling R, VA Palo Alto; Frayne SM, VA Palo Alto & Stanford University; Phibbs CS, VA Palo Alto & Stanford University;

Objectives:
Evaluate associations of Posttraumatic Stress Disorder (PTSD) and antepartum complications, to explore how PTSD's pathophysiology impacts pregnancy.

Methods:
Using national VA and Non-VA (Fee) data, we retrospectively studied all Veterans Health Administration (VA)-covered deliveries from 2000-2012 (n = 16,334). We identified mothers with any PTSD ICD-9 diagnoses in the year prior to delivery (active PTSD) or older diagnoses only (historical PTSD). We linked obstetric inpatient claims to VA medical and administrative data, identifying obstetric diagnoses and potential confounders including age, race, twins, pre-existing medical conditions, tobacco use, and depression, as well as Veteran-specific risk factors for PTSD: military deployment and history of military sexual trauma. Following bivariate analysis of the association between PTSD status (active/historical/none) and antepartum complications, we used generalized estimating equations (accounting for correlation of outcomes among women with repeat deliveries) to derive adjusted odds ratios (aOR [with 95% CI]) for 10 clinically relevant complications. We additionally examined the association of PTSD with proxies for obstetric complexity: repeat hospitalization, prolonged delivery hospitalization, and cesarean delivery.

Results:
Of 16,334 births analyzed, 3,049 (19%) were in mothers with PTSD diagnoses, 1,921 (12%) of which had active PTSD. Gestational diabetes complicated 6% of all births and preeclampsia 4.7%. Unadjusted analysis showed gestational diabetes, preeclampsia, pregnancy-induced hypertension, and fetal abnormality were highest in those with active PTSD (versus those with historical PTSD and those with none); bleeding complications, chorioamnionitis, premature rupture of membranes, fetal growth restriction and fetal demise had similar incidence regardless of PTSD status. After adjustment, active PTSD (reference = no PTSD) remained significantly associated with gestational diabetes (aOR 1.50 [1.22-1.85]) and preeclampsia (aOR 1.30 [1.05-1.60]). Pregnancies affected by active PTSD were more likely to have a prolonged ( > 4 day) delivery hospitalization (aOR 1.34 [1.11-1.61] and repeat hospitalizations (aOR 1.50 [1.27-1.78]), but not cesarean delivery.

Implications:
Antepartum PTSD is associated with increased risk of preeclampsia and gestational diabetes.

Impacts:
Pregnancies affected by active PTSD should be considered high-risk. The observed increase in preeclampsia and gestational diabetes is consistent with our nascent understanding of PTSD as a disruptor of neuroendocrine and cardiovascular health.