Spontaneous Preterm Birth Associated With PTSD in US Veterans

These study results highlight the importance of future research regarding the association between antidepressant dispensations and preeclampsia.

Spontaneous preterm birth among US veterans with active post-traumatic stress disorder (PTSD) is associated with preeclampsia or eclampsia and at least 6 dispensations of an antidepressant within 12 months prior to childbirth, according to study findings published in Women’s Health Issues.

Researchers conducted an observational study of singleton live births between 2005 and 2015 among veterans with PTSD active within 12 months prior to childbirth, and gathered data from administrative databases reimbursed by the Veterans Health Association using ICD-9 codes. Multivariable logistic regression was used to identify associated factors including age and race or ethnicity as a social construct. Exposures included pregnancy complications, psychiatric history, and maternal demographics.

The primary endpoint was spontaneous preterm birth. The researchers hypothesized receipt of mental health-related medication or psychiatric treatment in this population might affect spontaneous preterm birth rates independent of known demographic or obstetric factors that affect preterm births.

Researchers found 3242 births in the study period among veterans (age range 19-46 years) with active PTSD (2293 mothers; 64.5% non-Hispanic White, 21.1% non-Hispanic Black, 11.0% Hispanic), of which 249 (7.7%; similar racial and ethnic breakdown to the full cohort) were spontaneous preterm births.

[O]ur data do not suggest any direct relationship between antidepressant medications and preterm birth; rather, 6 (or more) dispensations is likely serving as a proxy for PTSD disease severity.

Veterans who gave birth preterm were older (P =.02) and had more substance use disorders (37.0% vs 29.5%; P =.01). Among the pregnant veterans with active PTSD, more than 61% had comorbid depression and more than 79% were receiving some type of mental health treatment. Overall treatment rates did not differ between groups.

There were no significant differences in the proportions of veterans with active PTSD and depression who gave birth preterm (60.6%, 151/249) vs term (61.5%, 1841/2993) (P =.79). Spontaneous preterm birth was associated with preeclampsia or eclampsia (adjusted odds ratio [aOR] 3.30; 95% CI, 1.67-6.54) and with 6 or more antidepressant medication dispensations within 12 months prior to childbirth (aOR 1.89; 95% CI, 1.29-2.77). At least 20% of participants in each group had at least 1 opioid dispensation within 12 months prior to childbirth.

Evidence of interaction between antidepressant use and preeclampsia on spontaneous preterm birth was not found (P =.39). Similar findings were shown when stratified by active concurrent depression.

Limitations of the study include the observational design, interpreting diagnoses from ICD codes, unknown obstetric histories, and lack of generalizability to nonveteran populations or to veterans who do not use VA services.

Study authors conclude, “[We] identified significant associations between spontaneous preterm birth and preeclampsia/eclampsia as well as between spontaneous preterm birth and 6 (or more) antidepressant medication dispensations in the year before childbirth. […] “[O]ur data do not suggest any direct relationship between antidepressant medications and preterm birth; rather, 6 (or more) dispensations is likely serving as a proxy for PTSD disease severity.”

References:

Panelli DM, Chan CS, Shaw JG, et al. An exploratory analysis of factors associated with spontaneous preterm birth among pregnant veterans with post-traumatic stress disorder. Womens Health Issues. Published online October 28, 2022. doi:10.1016/j.whi.2022.09.005