title: Posttraumatic stress disorder and risk of spontaneous preterm birth.
abstract: OBJECTIVE
  To evaluate the association between antenatal posttraumatic stress disorder (PTSD) and spontaneous preterm delivery.
  
  
  METHODS
  We identified antenatal PTSD status and spontaneous preterm delivery in a retrospective cohort of 16,334 deliveries covered by the Veterans Health Administration from 2000 to 2012. We divided mothers with PTSD into those with diagnoses present the year before delivery (active PTSD) and those only with earlier diagnoses (historical PTSD). We identified spontaneous preterm birth and potential confounders including age, race, military deployment, twins, hypertension, substance use, depression, and results of military sexual trauma screening and then performed multivariate regression to estimate adjusted odds ratio (OR) of spontaneous preterm delivery as a function of PTSD status.
  
  
  RESULTS
  Of 16,334 births, 3,049 (19%) were to mothers with PTSD diagnoses, of whom 1,921 (12%) had active PTSD. Spontaneous preterm delivery was higher in those with active PTSD (9.2%, n=176) than those with historical (8.0%, n=90) or no PTSD (7.4%, n=982) before adjustment (P=.02). The association between PTSD and preterm birth persisted, when adjusting for covariates, only in those with active PTSD (adjusted OR 1.35, 95% confidence interval [CI] 1.14-1.61). Analyses adjusting for comorbid psychiatric and medical diagnoses revealed the association with active PTSD to be robust.
  
  
  CONCLUSIONS
  In this cohort, containing an unprecedented number of PTSD-affected pregnancies, mothers with active PTSD were significantly more likely to suffer spontaneous preterm birth with an attributable two excess preterm births per 100 deliveries (95% CI 1-4). Posttraumatic stress disorder's health effects may extend, through birth outcomes, into the next generation.
authors.affiliation: Center for Innovation to Implementation, the National Center for Posttraumatic Stress Disorder, the Women's Health Section, and the Health Economics Resource Center, Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, and the March of Dimes Center for Prematurity Research at Stanford, the Centers for Health Policy/Primary Care & Outcomes Research, the Division of General Medical Disciplines, and the Departments of Obstetrics & Gynecology and Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Shaw
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Rachel
authors.initials: R
authors.lastname: Kimerling
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
authors.forename: Kate A
authors.initials: KA
authors.lastname: Shaw
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D058014:Veterans Health; D055815:Young Adult