title: Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study.
abstract: BACKGROUND
  Prenatal and peripartum trauma may be associated with poor maternal-fetal outcomes. However, relatively few data on these associations exist from low-middle income countries, and populations in transition.
  
  
  OBJECTIVE
  We investigated the prevalence and risk factors for maternal trauma and posttraumatic stress disorder (PTSD), and their association with adverse birth outcomes in the Drakenstein Child Health Study, a South African birth cohort study.
  
  
  METHODS
  Pregnant women were recruited from two clinics in a peri-urban community outside Cape Town. Trauma exposure and PTSD were assessed using diagnostic interviews; validated self-report questionnaires measured other psychosocial characteristics. Gestational age at delivery was calculated and birth outcomes were assessed by trained staff. Multiple logistic regression explored risk factors for trauma and PTSD; associations with birth outcomes were investigated using linear regression. Potential confounders included study site, socioeconomic status (SES), and depression.
  
  
  RESULTS
  A total of 544 mother-infant dyads were included. Lifetime trauma was reported in approximately two-thirds of mothers, with about a third exposed to past-year intimate partner violence (IPV). The prevalence of current/lifetime PTSD was 19%. In multiple logistic regression, recent life stressors were significantly associated with lifetime trauma, when controlling for SES, study site, and recent IPV. Childhood trauma and recent stressors were significantly associated with PTSD, controlling for SES and study site. While no association was observed between maternal PTSD and birth outcomes, maternal trauma was significantly associated with a 0.3 unit reduction (95% CI: 0.1; 0.5) in infant head-circumference-for-age z-scores (HCAZ scores) at birth in crude analysis, which remained significant when adjusted for study site and recent stressors in a multivariate regression model.
  
  
  CONCLUSIONS
  In this exploratory study, maternal trauma and PTSD were found to be highly prevalent, and preliminary evidence suggested that trauma may adversely affect fetal growth, as measured by birth head circumference. However, these findings are limited by a number of methodological weaknesses, and further studies are required to extend findings and delineate causal links and mechanisms of association.
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.|Medical Research Council (MRC) Unit on Anxiety & Stress Disorders, Cape Town, South Africa; nastassja.koen@gmail.com.
authors.forename: Nastassja
authors.initials: N
authors.lastname: Koen
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Brittain
authors.affiliation: Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Donald
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa.
authors.forename: Whitney
authors.initials: W
authors.lastname: Barnett
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Sheri
authors.initials: S
authors.lastname: Koopowitz
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Maré
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town and Medical Research Council (MRC) Unit on Child & Adolescent Health, Cape Town, South Africa.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Zar
authors.affiliation: Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.|Medical Research Council (MRC) Unit on Anxiety & Stress Disorders, Cape Town, South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
keywords: PTSD; South Africa; Trauma; birth cohort; birth outcomes; intergenerational; pregnancy