Post-traumatic stress disorder and adverse pregnancy and birth outcomes: a population-based study

Background: Post-traumatic stress disorder (PTSD) is associated with functional impairment and primarily affects women, with potential impacts on reproductive health. However, evidence regarding pregnancy and neonatal outcomes among women with PTSD prior to delivery remains limited.Objective: To examine whether PTSD is associated with adverse pregnancy and neonatal outcomes in a nationwide population-based cohort of women in Taiwan.Method: This population-based matched cohort study used Taiwan's Birth Reporting and National Health Insurance Research Database. Pregnant women with PTSD within 1 year before delivery were identified and matched 1:1 with comparison subjects using propensity scores. Primary outcomes included adverse pregnancy outcomes (cesarean delivery, stillbirth) and neonatal outcomes (low birth weight, preterm birth, small for gestational age, abnormal 5-minute Apgar score, and congenital defects). Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).Results: The matched cohorts included 4,353 women with PTSD and 4,353 without PTSD. Relevant findings show that PTSD was associated with increased risks of cesarean delivery (aOR 1.18; 95% CI 1.08-1.28), low birth weight (aOR 1.19; 95% CI 1.04-1.37), and preterm birth (aOR 1.21; 95% CI 1.06-1.38). These associations were more obvious among women aged ≤ 35 years and those with gestational diabetes or anemia. Nevertheless, no significant associations were observed for stillbirth, small for gestational age, abnormal Apgar scores, or congenital anomalies.Conclusions: Pre-delivery PTSD slightly increased risks of cesarean delivery, low birth weight, and preterm birth. However, the lack of association with severe neonatal outcomes, such as congenital anomalies and stillbirth, provides essential reassurance. These findings underscore the importance of integrating mental health monitoring into routine prenatal care to optimise maternal and infant well-being without causing undue alarm.