Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA, USA.
Leidos, Inc, San Diego, CA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9053-9060. doi: 10.1080/14767058.2021.2013796. Epub 2021 Dec 9.
Posttraumatic stress disorder (PTSD) affects 3.6-9.7% of women, and has been associated with adverse outcomes in pregnancy; however, associations with prenatal care (PNC) utilization are not clear.
To evaluate associations of PTSD in pregnancy with PNC utilization and adverse infant outcomes in an active-duty military population (a population with universal health insurance).
This was a retrospective cohort study of pregnant active-duty service members in Department of Defense Birth and Infant Health Research program data from 2007 to 2014. Administrative medical encounter data were used to define PTSD cases and outcomes of interest. Descriptive statistics and multivariable log-binomial regression compared PNC utilization and adverse infant outcomes (preterm birth, small for gestational age [SGA], major birth defects) among service members with current PTSD (defined as PTSD in the year prior to pregnancy or during pregnancy) to those without current PTSD.
Of the 103,221 singleton live births identified, 1657 (1.6%) were born to active-duty service members diagnosed with current PTSD. Service members with PTSD were more likely to initiate PNC in the first trimester (93.5% vs. 90.2%) and score adequate plus on the Adequacy of Prenatal Care Utilization Index (63.2% vs. 40.0%) compared to service members without PTSD. PTSD case status was not associated with preterm birth, SGA, or major birth defects, regardless of the adjustment set used (fully adjusted RR 0.96, 95% CI 0.82-1.13; RR 1.08, 95% CI 0.79-1.48; and RR 1.03, 95% CI 0.79-1.34, respectively).
For pregnant service members with current PTSD, no associations with adverse infant outcomes were noted, and these patients initiated care earlier and had higher PNC utilization scores compared to pregnant service members without current PTSD. Universal health care coverage and utilization of PNC in this population may mitigate adverse pregnancy outcomes observed in civilian populations of patients with PTSD.
创伤后应激障碍（PTSD）影响 3.6-9.7%的女性，并与妊娠不良结局相关；然而，与产前保健（PNC）的利用情况并不明确。
评估现役军人（具有全民健康保险的人群）中妊娠期间 PTSD 与 PNC 利用和不良婴儿结局之间的关联。
这是一项 2007 年至 2014 年期间，在国防部生育和婴儿健康研究计划数据中进行的现役军人妊娠回顾性队列研究。行政医疗就诊数据用于定义 PTSD 病例和感兴趣的结局。描述性统计和多变量对数二项式回归比较了当前 PTSD（定义为妊娠前一年或妊娠期间患有 PTSD）的现役军人与没有当前 PTSD 的现役军人的 PNC 利用和不良婴儿结局（早产、小于胎龄儿[SGA]、重大出生缺陷）。
在确定的 103221 例单胎活产中，有 1657 例（1.6%）出生于现役军人，诊断为当前 PTSD。与没有 PTSD 的现役军人相比，患有 PTSD 的现役军人更有可能在孕早期开始 PNC（93.5%比 90.2%），并且在产前保健利用指数（Adequacy of Prenatal Care Utilization Index）上的评分足够高（63.2%比 40.0%）。无论使用何种调整集（完全调整 RR 0.96，95%CI 0.82-1.13；RR 1.08，95%CI 0.79-1.48；RR 1.03，95%CI 0.79-1.34），PTSD 病例状态均与早产、SGA 或重大出生缺陷无关。
对于当前患有 PTSD 的孕妇，没有观察到与不良婴儿结局相关的情况，与当前没有 PTSD 的孕妇相比，这些患者更早开始接受治疗，并且 PNC 利用率评分更高。在这一人群中，全民健康保险覆盖范围和 PNC 的利用可能减轻了在 PTSD 患者的平民人群中观察到的不良妊娠结局。
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