Post-traumatic stress disorder (PTSD), especially when caused by abuse in childhood, increases the risk of preterm birth and lower birth weight, a new study finds.
Researchers from the University of Michigan studied 839 nulliparous women divided into 3 cohorts: PTSD-positive (255), trauma-exposed resilient (no psychological symptoms; 307), and not exposed to trauma (277). They also divided the women into groups with and without a history of childhood abuse. Forty-one percent of the women were African American.
Women who suffered from PTSD while pregnant gave birth to babies with a mean birth weight 283 g less than infants of trauma-exposed resilient women and 221 g less than infants of nonexposed women. PTSD was also associated with shorter gestation. Adverse outcomes were most strongly linked to PTSD subsequent to childhood abuse. Prenatal care didn’t produce better outcomes among women abused in childhood. The study was published in online July 27 in BJOG: An International Journal of Obstetrics and Gynaecology.
“It is the subset of women whose PTSD is secondary to childhood abuse who are most vulnerable to these lower birth weight and shorter gestation outcomes and…prenatal care is not protective for them,” the authors write. They note that women with abuse-related PTSD may start prenatal care late or skip visits to avoid reminders of previous trauma, such as vaginal examinations. Women who do adhere to prenatal visits may experience exacerbations of PTSD that increase stress and undermine care.
Among African American women, PTSD was a stronger predictor of shorter gestation than race and a nearly equal predictor of birth weight. “Abuse-related PTSD may be an additional or alternative explanation for adverse perinatal outcomes associated with low socioeconomic status and African American race in the USA,” the researchers write. African American women and women with low sociodemographic status tend to have a higher rate of PTSD during pregnancy.
The authors recommend that screening for PTSD, childhood abuse, and depression should occur at the start of prenatal care.