Women Veterans with PTSD at Significantly Increased Risk of Spontaneous Pre-term Delivery
BACKGROUND:
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.
FINDINGS:
- 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.
LIMITATIONS:
- 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.
IMPLICATIONS:
- 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.
AUTHOR/FUNDING INFORMATION:
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).
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.
