Post-traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia.
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.



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).



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.



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.
HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
Jonathan G
0000-0001-7884-3604
JG
Shaw
HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
Steven M
SM
Asch
VA Puget Sound Health Care System, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, Seattle, WA.|Department of Health Services, University of Washington School of Public Health, Seattle, WA.
Jodie G
JG
Katon
Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, CA.
Kate A
KA
Shaw
HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.
Rachel
R
Kimerling
HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA.
Susan M
SM
Frayne
HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.|Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA.
Ciaran S
CS
Phibbs
D000328:Adult; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007028:Hypothalamic Hormones / Q000378:metabolism; D007231:Infant, Newborn; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology; D037841:Pregnant People / Q000523:psychology*; D047928:Premature Birth / Q000209:etiology / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000378:metabolism / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology; D058014:Veterans Health; D055815:Young Adult
D007028:Hypothalamic Hormones
PTSD; gestational diabetes; preeclampsia; stress