Shaw Jonathan G, Asch Steven M, Katon Jodie G, Shaw Kate A, Kimerling Rachel, Frayne Susan M, Phibbs Ciaran S
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.
Paediatr Perinat Epidemiol. 2017 May;31(3):185-194. doi: 10.1111/ppe.12349. Epub 2017 Mar 22.
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.
先前的研究表明，创伤后应激障碍（PTSD）预示着早产风险增加，但因果途径尚不确定。我们评估PTSD与产前并发症之间的关联，以探讨PTSD的病理生理学如何影响妊娠。
这项对2000年至2012年退伍军人健康管理局（VA）承保的所有分娩进行的回顾性队列分析，使用了VA临床和管理数据。使用ICD-9诊断代码确定当前患有PTSD的母亲（即产前一年内出现的代码）以及有既往PTSD的母亲。医疗和管理数据用于确定相关的产科诊断、人口统计学和健康状况以及军事部署历史。我们使用具有稳健误差方差的泊松回归来得出PTSD与五种临床相关产前并发症[妊娠期糖尿病（GDM）、先兆子痫、妊娠高血压、生长受限和胎盘早剥]之间关联的调整后相对风险估计值（RR）。次要结局包括产科复杂性的指标（再次住院、延长分娩住院时间和剖宫产）。
在15986例单胎分娩中，2977例（19%）母亲被诊断患有PTSD（1880例（12%）为当前患有PTSD）。患有GDM并发症的母亲占所有分娩的4.9%，患有先兆子痫的母亲占4.6%。调整后，当前PTSD诊断（参考 = 无PTSD）与GDM风险增加（RR 1.4，95%置信区间（CI）1.2，1.7）和先兆子痫风险增加（RR 1.3，95%CI 1.1，1.6）相关。PTSD还预示着延长（>4天）分娩住院时间（RR 1.2，95%CI 1.01，1.4）和再次住院（RR 1.4，95%CI 1.2，1.6），但与剖宫产无关。
观察到的PTSD与GDM和先兆子痫之间的关联与我们对PTSD作为神经内分泌和心血管健康破坏者的初步理解一致。
