Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
VA Health Economics Resource Center (HERC), VA Palo Alto Health Care System, 795 Willow Rd, Bldg 324 152-MPD Ci2i, Menlo Park, CA, USA.
Womens Health Issues. 2023 Mar-Apr;33(2):191-198. doi: 10.1016/j.whi.2022.09.005. Epub 2022 Oct 28.
Pregnant veterans with post-traumatic stress disorder (PTSD) are at increased risk for spontaneous preterm birth, yet the underlying reasons are unclear. We examined factors associated with spontaneous preterm birth among pregnant veterans with active PTSD.
This was an observational study of births from administrative databases reimbursed by the Veterans Health Association (VA) between 2005 and 2015. Singleton livebirths among veterans with active PTSD within 12 months prior to childbirth were included. The primary outcome was spontaneous preterm birth. Maternal demographics, psychiatric history, and pregnancy complications were evaluated as exposures. Covariates significant on bivariate analysis, as well as age and race/ethnicity as a social construct, were included in multivariable logistic regression to identify factors associated with spontaneous preterm birth. Additional analyses stratified significant covariates by the presence of active concurrent depression and explored interactions between antidepressant use and preeclampsia.
Of 3,242 eligible births to veterans with active PTSD, 249 (7.7%) were spontaneous preterm births. The majority of veterans with active PTSD (79.1%) received some type of mental health treatment, and active concurrent depression was prevalent (61.4%). Preeclampsia/eclampsia (adjusted odds ratio [aOR] 3.30, 95% confidence interval [CI] 1.67-6.54) and ≥6 antidepressant medication dispensations within 12 months prior to childbirth (aOR 1.89, 95% CI 1.29-2.77) were associated with spontaneous preterm birth. No evidence of interaction was seen between antidepressant use and preeclampsia on spontaneous preterm birth (p=0.39). Findings were similar when stratified by active concurrent depression.
Among veterans with active PTSD, preeclampsia/eclampsia and ≥6 antidepressant dispensations were associated with spontaneous preterm birth. While the results do not imply that people should discontinue needed antidepressants during pregnancy in veterans with PTSD, research into these factors might inform preterm birth prevention strategies for this high-risk population.
患有创伤后应激障碍（PTSD）的孕妇早产风险增加，但潜在原因尚不清楚。我们研究了与患有活跃 PTSD 的孕妇早产相关的因素。
这是一项对退伍军人健康协会（VA）在 2005 年至 2015 年期间报销的行政数据库中妊娠的观察性研究。纳入在分娩前 12 个月内患有活跃 PTSD 的退伍军人中，单胎活产。主要结局是自发性早产。评估产妇人口统计学特征、精神病史和妊娠并发症作为暴露因素。单变量分析中显著的协变量，以及年龄和种族/民族作为社会结构，被纳入多变量逻辑回归，以确定与自发性早产相关的因素。对有或无活跃并发抑郁症的显著协变量进行了额外分析，并探讨了抗抑郁药使用与子痫前期之间的相互作用。
在 3242 例符合条件的 PTSD 活跃退伍军人分娩中，249 例（7.7%）为自发性早产。大多数患有活跃 PTSD 的退伍军人（79.1%）接受了某种类型的心理健康治疗，且活跃并发抑郁症很常见（61.4%）。子痫前期/子痫（调整后的优势比[aOR] 3.30，95%置信区间[CI] 1.67-6.54）和分娩前 12 个月内≥6 次抗抑郁药配药（aOR 1.89，95% CI 1.29-2.77）与自发性早产相关。抗抑郁药使用与子痫前期之间未发现与自发性早产有关的相互作用的证据（p=0.39）。在按活跃并发抑郁症分层时，结果相似。
在患有活跃 PTSD 的退伍军人中，子痫前期/子痫和≥6 次抗抑郁药配药与自发性早产有关。虽然这些结果并不意味着 PTSD 退伍军人在怀孕期间应停止使用必要的抗抑郁药，但对这些因素的研究可能为这一高危人群的早产预防策略提供信息。
