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Cited by 331Maternal Mental Health During Pregnancy and PostpartumPregnancy and Medication ImpactPosttraumatic Stress Disorder Research

Pregnant women with posttraumatic stress disorder and risk of preterm birth

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Yonkers, Kimberly Ann, Smith, Megan V., Forray, Ariadna, Epperson, C. Neill, Costello, Darce, Lin, Haiqun, Belanger, Kathleen·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.558PMC PMC4134929
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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.

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  • PTSD during pregnancy is associated with adverse perinatal outcomes, including preterm birth, low infant birthweight, postpartum depression, and impaired maternal-infant bonding.

    “PTSD during pregnancy is associated with adverse perinatal outcomes, including preterm birth, low infant birthweight, postpartum depression, and impaired maternal-infant bonding [3–5].”

    From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [5]

    The Discussion reports elevated preterm-birth risk among women with likely PTSD, but says the increase was accounted for by those with concurrent major depressive episodes. It also reports a previous study in which women with PTSD delivered smaller babies; that does not establish low birthweight in this study. Our copy does not address postpartum depression or impaired maternal–infant bonding. (LLM, conf=0.88)

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Authors
Yonkers, K. A., Smith, M. V., Forray, A., Epperson, C. N., Costello, D., Lin, H., & Belanger, K.
Affiliations
  • Yale University (US)
  • University of Pennsylvania (US)
  • Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
Corresponding author
Yonkers, Kimberly Ann
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-08-01
Volume
71
Issue
8
Pages
897
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.558
PMC
PMC4134929
OpenAlex
W2170547299
Cited by
331
References
65
Citations by year
2026: 10 · 2025: 26 · 2024: 16 · 2023: 16 · 2022: 19 · 2021: 21 · 2020: 62 · 2019: 23 · 2018: 20 · 2017: 78 · 2016: 16 · 2015: 21 · 2014: 3
FWCI
38.96
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000142)
  • National Institute of Mental Health (P50MH099910, T32MH014235)
  • National Institute on Drug Abuse (K12DA031050, K24DA030301, R01DA019135)
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD045735)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
post-traumatic stress disorder, preterm birth, pregnancy, major depressive episode, antidepressant use, benzodiazepine use, serotonin reuptake inhibitors, anxiolytics, psychiatric comorbidity, maternal mental health, drug safety in pregnancy, Composite International Diagnostic Interview, preterm birth risk factors
MeSH terms
Adult, Antidepressive Agents, Benzodiazepines, Connecticut, Major Depressive Disorder, Female, Humans, Massachusetts, Pregnancy, Pregnancy Complications, Stress Disorders, Post-Traumatic, Comorbidity, Selective Serotonin Reuptake Inhibitors, Risk Assessment, Premature Birth

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