Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and
Jonathan G Shaw1,2, Steven M Asch1,2, Jodie G Katon3,4
1HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.
Insights
Post-traumatic Stress Disorder (PTSD) in pregnant individuals is linked to higher risks of gestational diabetes and preeclampsia. This study explored how PTSD impacts pregnancy complications, highlighting potential neuroendocrine and cardiovascular pathways.
Area of Science:
- Obstetrics and Gynecology
- Psychiatry
- Epidemiology
Background:
- Previous research indicates Post-traumatic Stress Disorder (PTSD) is associated with an increased risk of preterm birth.
- The precise causal mechanisms linking PTSD to adverse pregnancy outcomes remain unclear.
- This study investigates the relationship between PTSD and antepartum complications to elucidate potential pathophysiological impacts on pregnancy.
Purpose of the Study:
- To examine the association between current and historical Post-traumatic Stress Disorder (PTSD) diagnoses and specific antepartum complications.
- To explore the impact of PTSD on pregnancy outcomes, including gestational diabetes, preeclampsia, and delivery hospitalizations.
- To contribute to understanding the pathophysiological pathways through which PTSD may affect maternal health during pregnancy.
Main Methods:
- Retrospective cohort analysis of Veterans Health Administration (VA)-covered deliveries from 2000-2012.
- Identification of mothers with current or historical PTSD using ICD-9 codes.
- Poisson regression used to calculate adjusted relative risks (RR) for PTSD association with gestational diabetes, preeclampsia, gestational hypertension, growth restriction, abruption, and delivery hospitalization outcomes.
Main Results:
- A current Post-traumatic Stress Disorder (PTSD) diagnosis was associated with increased risks of gestational diabetes (RR 1.4) and preeclampsia (RR 1.3).
- PTSD was also linked to prolonged delivery hospitalizations (RR 1.2) and repeat hospitalizations (RR 1.4).
- No significant association was found between PTSD and cesarean delivery.
Conclusions:
- The findings support the association between Post-traumatic Stress Disorder (PTSD) and increased risks for gestational diabetes and preeclampsia.
- These results align with emerging evidence of PTSD's role in disrupting neuroendocrine and cardiovascular health.
- Further research into the pathophysiological mechanisms is warranted to inform clinical management.
Background:
Prior work shows that Post-traumatic Stress Disorder (PTSD) predicts an increased risk of preterm birth, but the causal pathway(s) are uncertain. We evaluate the associations between PTSD and antepartum complications to explore how PTSD's pathophysiology impacts pregnancy.
Methods:
This retrospective cohort analysis of all Veterans Health Administration (VA)-covered deliveries from 2000-12 used the data of VA clinical and administration. Mothers with current PTSD were identified using the ICD-9 diagnostic codes (i.e. code present during the antepartum year), as were those with historical PTSD. Medical and administrative data were used to identify the relevant obstetric diagnoses, demographics and health, and military deployment history. We used Poisson regression with robust error variance to derive the adjusted relative risk estimates (RR) for the association of PTSD with five clinically relevant antepartum complications [gestational diabetes (GDM), preeclampsia, gestational hypertension, growth restriction, and abruption]. Secondary outcomes included proxies for obstetric complexity (repeat hospitalisation, prolonged delivery hospitalisation, and caesarean delivery).
Results:
Of the 15 986 singleton deliveries, 2977 (19%) were in mothers with PTSD diagnoses (1880 (12%) current PTSD). Mothers with the complication GDM were 4.9% and those with preeclampsia were 4.6% of all births. After adjustment, a current PTSD diagnosis (reference = no PTSD) was associated with an increased risk of GDM (RR 1.4, 95% confidence interval (CI) 1.2, 1.7) and preeclampsia (RR 1.3, 95% CI 1.1, 1.6). PTSD also predicted prolonged (>4 day) delivery hospitalisation (RR 1.2, 95% CI 1.01, 1.4), and repeat hospitalisations (RR 1.4, 95% CI 1.2, 1.6), but not caesarean delivery.
Conclusions:
The observed association of PTSD with GDM and preeclampsia is consistent with our nascent understanding of PTSD as a disruptor of neuroendocrine and cardiovascular health.
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