Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug;71(8):897-904.
doi: 10.1001/jamapsychiatry.2014.558.

Pregnant women with posttraumatic stress disorder and risk of preterm birth

Kimberly Ann Yonkers  1 , Megan V Smith  2 , Ariadna Forray  3 , C Neill Epperson  4 , Darce Costello  3 , Haiqun Lin  5 , Kathleen Belanger  5
Affiliations

Pregnant women with posttraumatic stress disorder and risk of preterm birth

Kimberly Ann Yonkers et al. JAMA Psychiatry. 2014 Aug.

Abstract

Importance: Posttraumatic stress disorder (PTSD) occurs in about 8% of pregnant women. Stressful conditions, including PTSD, are inconsistently linked to preterm birth. Psychotropic treatment has been frequently associated with preterm birth. Identifying whether the psychiatric illness or its treatment is independently associated with preterm birth may help clinicians and patients when making management decisions.

Objective: To determine whether a likely diagnosis of PTSD or antidepressant and benzodiazepine treatment during pregnancy is associated with risk of preterm birth. We hypothesized that pregnant women who likely had PTSD and women receiving antidepressant or anxiolytic treatment would be more likely to experience preterm birth.

Design, setting, and participants: Longitudinal, prospective cohort study of 2654 women who were recruited before 17 completed weeks of pregnancy from 137 obstetrical practices in Connecticut and Western Massachusetts.

Exposures: Posttraumatic stress disorder, major depressive episode, and use of antidepressant and benzodiazepine medications.

Main outcomes and measures: Preterm birth, operationalized as delivery prior to 37 completed weeks of pregnancy. Likely psychiatric diagnoses were generated through administration of the Composite International Diagnostic Interview and the Modified PTSD Symptom Scale. Data on medication use were gathered at each participant interview.

Results: Recursive partitioning analysis showed elevated rates of preterm birth among women with PTSD. A further split of the PTSD node showed high rates for women who met criteria for a major depressive episode, which suggests an interaction between these 2 exposures. Logistic regression analysis confirmed risk for women who likely had both conditions (odds ratio [OR], 4.08 [95% CI, 1.27-13.15]). For each point increase on the Modified PTSD Symptom Scale (range, 0-110), the risk of preterm birth increased by 1% to 2%. The odds of preterm birth are high for women who used a serotonin reuptake inhibitor (OR, 1.55 [95% CI, 1.02-2.36]) and women who used a benzodiazepine medication (OR, 1.99 [95% CI, 0.98-4.03]).

Conclusions and relevance: Women with likely diagnoses of both PTSD and a major depressive episode are at a 4-fold increased risk of preterm birth; this risk is greater than, and independent of, antidepressant and benzodiazepine use and is not simply a function of mood or anxiety symptoms.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: In the past year, Dr Yonkers received royalties from UpToDate. Dr Epperson discloses receipt of Investigator-Initiated Research support from Pfizer, Johnson and Johnson, Abbott, AbbVie, and Merck. No other disclosures are reported.

Figures

Figure 1
Figure 1. Patient Flowchart
PTSD indicates posttraumatic stress disorder.
Figure 2
Figure 2. Classification Tree for Risk of Preterm Birth
Ovals indicate decision nodes, and rectangles indicate terminal nodes. The number of women and the preterm birth rate (in parentheses) are displayed within each node for the women in the training sample and for the women in the testing sample. MDD indicates major depressive disorder; PTB, preterm birth; and PTSD, posttraumatic stress disorder.
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention (CDC) Publications and Information Products. National Vital Statistics Report. Infant mortality statistics from the 2009 period linked birth/infant dataset. [Accessed May 9, 2014];CDC website. http://www.cdc.gov/nchs/products/nvsr.htm.
    1. Berkowitz GS, Kasl SV. The role of psychosocial factors in spontaneous preterm delivery. J Psychosom Res. 1983;27(4):283–290. - PubMed
    1. Copper RL, Goldenberg RL, Das A, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. Am J Obstet Gynecol. 1996;175(5):1286–1292. - PubMed
    1. Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P. Maternal stress and preterm birth. Am J Epidemiol. 2003;157(1):14–24. - PubMed
    1. Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S. Do stressful life events affect duration of gestation and risk of preterm delivery? Epidemiology. 1996;7(4):339–345. - PubMed

Publication types

MeSH terms