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2019 HSR&D/QUERI National Conference Abstract

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Lead/Presenter: Cathryn Holzhauer,  VA Central Western Massachusetts
All Authors: Holzhauer CG (VA Central Western Massahcusetts, Univ of Massachusetts Medical School), Copeland, LA (VA Central Western Massahcusetts, Univ of Massachusetts Medical School), Kroll-Derosiers, A (Univ of Massachusetts Medical School) Kinney, R (VA Central Western Massahcusetts, Univ of Massachusetts Medical School) Bastian, L (VA Connecticut healthcare center (West Haven COIN); Yale School of Medicine) Mattocks, K (VA Connecticut healthcare center (West Haven COIN); Yale School of Medicine)

Exposure to stress and posttraumatic stress disorder (PTSD) have been identified as significant predictors of high-risk health behaviors among women, such as alcohol misuse, during and after pregnancy. This study examined alcohol misuse among pregnant and postpartum women Veterans, and whether prenatal stress was related to an increase in postpartum alcohol misuse. PTSD was examined as a moderator of this association.

Data were drawn from the Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study, a multisite, mixed-methods VA study. Initial interviews were conducted at 20 weeks gestation, with second interviews at 8-16 weeks post-delivery. COMFORT data on questions about stress exposure (e.g., loss of job, separation/divorce, military deployment) in the year prior to birth were summed and used in current analyses. PTSD diagnosis and scores on the Alcohol Use Disorders Identification Test (AUDIT-C) in the two years before and after each woman's due date were drawn from medical records.

Of the 538 women, 22.5% had a positive AUDIT-C in the two years before or after the child's birth. None of the women had a positive AUDIT-C score during pregnancy. An increase in AUDIT-C score from prenatal to postpartum period was associated with greater prenatal exposure to stressful events (r = .12, p = .01). A moderation analysis showed that the association between stress exposure and changes in AUDIT-C was moderated by PTSD diagnosis (F = 5.79, p = .001). Specifically, women without PTSD showed little change in their AUDIT-C from the period before pregnancy to the period after pregnancy. Change in AUDIT-C among women with PTSD, however, was dependent on prenatal stress exposure. Women with PTSD who had less stress exposure showed the greatest decrease in AUDIT-C, while women with PTSD who had more stress exposure showed the greatest increases in AUDIT-C score.

Prenatal stress exposure increases risk for postpartum alcohol misuse, particularly among women Veterans with PTSD.

Postpartum depression and stress have been shown to be higher among women who use alcohol and/or drugs. Identifying factors that contribute to alcohol use during the postpartum period has important preventative implications for maternal and child health.