Jonathan G Shaw1,2, Steven M Asch1,2, Jodie G Katon3,4, Kate A Shaw5, Rachel Kimerling1,6, Susan M Frayne1,2, Ciaran S Phibbs1,7,8. 1. HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA. 2. Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA. 3. VA Puget Sound Health Care System, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, Seattle, WA. 4. Department of Health Services, University of Washington School of Public Health, Seattle, WA. 5. Department of Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, CA. 6. National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA. 7. Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA. 8. Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA.
Abstract
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.
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.
Authors: Jonathan G Shaw; Vilija R Joyce; Susan K Schmitt; Susan M Frayne; Kate A Shaw; Beate Danielsen; Rachel Kimerling; Steven M Asch; Ciaran S Phibbs Journal: Health Serv Res Date: 2018-09-10 Impact factor: 3.402
Authors: Jodie G Katon; Laurie Zephyrin; Anne Meoli; Avanthi Hulugalle; Jeane Bosch; Lisa Callegari; Ileana V Galvan; Kristen E Gray; Kristin O Haeger; Claire Hoffmire; Silvina Levis; Erica W Ma; Jennifer E Mccabe; Yael I Nillni; Suzanne L Pineles; Shivani M Reddy; David A Savitz; Jonathan G Shaw; Elizabeth W Patton Journal: Semin Reprod Med Date: 2019-04-19 Impact factor: 1.303
Authors: Laura J Miller; Sandy Rowlands; Laura Esposito; Margaret Altemus; Jennifer L Strauss Journal: J Gen Intern Med Date: 2022-08-30 Impact factor: 6.473
Authors: Christine Maric-Bilkan; Vikki M Abrahams; S Sonia Arteaga; Ghada Bourjeily; Kirk P Conrad; Janet M Catov; Maged M Costantine; Brian Cox; Vesna Garovic; Eric M George; Alison D Gernand; Arun Jeyabalan; S Ananth Karumanchi; Aaron D Laposky; Menachem Miodovnik; Megan Mitchell; Victoria L Pemberton; Uma M Reddy; Mark K Santillan; Eleni Tsigas; Kent L R Thornburg; Kenneth Ward; Leslie Myatt; James M Roberts Journal: Hypertension Date: 2019-04 Impact factor: 10.190
Authors: Deirdre A Quinn; Stephanie W Edmonds; Xinhua Zhao; Sonya Borrero; Ginny L Ryan; Laurie C Zephyrin; Lisa S Callegari Journal: Matern Child Health J Date: 2021-04-30