Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website
Publication Briefs

Women Veterans with PTSD at Significantly Increased Risk of Spontaneous Pre-term Delivery

Pre-term birth is a leading cause of infant morbidity and mortality. In the United States, 12% of deliveries are pre-term, and roughly half are spontaneous as opposed to medically indicated. A growing number of studies suggest a role for psychosocial factors, such as maternal stress and depression; however, the effect of PTSD remains unclear. Using VA data and a retrospective cohort of 16,334 deliveries covered by VA from 2000 to 2012, investigators in this study examined the association between PTSD and spontaneous pre-term delivery (before 37 weeks). Investigators identified a diagnosis of PTSD during VA healthcare visits between 1997 and 2012, ensuring data for a minimum of three years prior to delivery. They also distinguished between "active" PTSD (diagnosis made within 365 days of delivery) and "historical" PTSD. Data on exposure to two potential traumas – military sexual trauma (MST) and recent military deployment – also were examined. Information on patient demographics, medical and mental health comorbidities was included in the analyses.


  • Mothers with active PTSD were at 35% increased odds of having a spontaneous pre-term delivery (two excess pre-term births per 100 deliveries), even after adjusting for psychiatric and medical comorbidities. Thus, PTSD's health effects may extend, through birth outcomes, into the next generation.
  • Of 16,334 births, 3,049 (19%) were in mothers with a diagnosis of PTSD, of which 1,921 (12%) had active PTSD. Spontaneous pre-term delivery was higher in those with active PTSD (9%, n=176) compared to those with historical (8%, n=90) or no PTSD (7%, n=982).
  • Women Veterans with active PTSD were significantly more likely to have been deployed (45%) than those with historical (32%) or no PTSD (28%).
  • Women Veterans with active and historical PTSD were more likely to report MST (57% and 46%) than those without PTSD (16%), and they carried a significantly higher burden of active comorbid mental health, drug, and alcohol-related diagnoses.


  • Investigators were unable to measure the degree of prematurity, and did not account for medically indicated (e.g., induced) pre-term births.
  • Military deployment and MST were the only two trauma exposures examined.
  • Investigators did not adjust for psychiatric medication use or level or location of prenatal care.


  • VA's Office of Women's Health Services has informed all VA facility Women Veterans Program Managers that pregnant veterans with active PTSD should be considered high-risk pregnancies.

This study was funded by HSR&D. Drs. Shaw, Asch, Kimerling, Frayne, and Phibbs are part of HSR&D's Center for Innovation to Implementation: Fostering High-Value Care, Palo Alto, CA. Dr. Asch also is co-Director of the HIV/Hepatitis-Quality Enhancement Research Initiative (QUERI).

PubMed Logo Shaw J, Asch S, Kimerling R, Frayne S, Shaw K, and Phibbs C. Post-traumatic Stress Disorder and Risk of Spontaneous Pre-term Birth. Obstetrics & Gynecology. December 2014;124(6):1111-19.

Related Briefs

» next 81 Women's Health Briefs...

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.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.