PTSD and major depressive episode linked with preterm birth

1. Women likely experiencing posttraumatic stress disorder and major depressive episodes during pregnancy may be at a 4-fold increased risk of preterm birth. 

2. The association of posttraumatic stress disorder and major depressive episodes with preterm birth is independent of many potential confounders, including other mood and anxiety symptoms and use of antidepressants and benzodiazepines. 

Evidence Rating Level: 2 (Good)           

Study Rundown: Preterm birth, defined as a birth earlier than 37 weeks of gestation, is a leading cause of infant mortality worldwide, and has been associated with psychosocial stress. This study sought to unambiguously characterize the association between severe stress-related conditions like posttraumatic stress disorder (PTSD) and preterm birth. Women were recruited to the study before their 17^th week of gestation and exposures of major depressive episodes (MDE) and PTSD were assessed using the validated CIDI and MPSS surveys respectively.

Analysis showed that there was a significant interaction between a diagnosis of PTSD and a diagnosis of MDE and together, these exposures led to a 4-fold increase in the risk of experiencing preterm birth. Preterm birth was also independently associated with SRI use, history of previous preterm birth, and increasing maternal age. The authors did find significance between PTSD and MDE and increased preterm birth risk, but it is important to note the confidence interval was quite wide. Though this study may be limited by the design and delivery of surveys to assess PTSD and MDE, it is the first study to find a significant and biologically plausible connection between maternal stress disorders and preterm birth.

Click to read the study in JAMA Psychiatry

Relevant Reading: Social adversity, low birth weight, and preterm delivery

In-Depth [prospective cohort]: This study followed 2654 women who were recruited before the 17^th week of their pregnancy. CIDI and MPSS surveys were administered each trimester and found that 129 women (4.9%) in total screened positive for PTSD. Of 9525 volunteers, 1905 screened positive for prior depressive episodes, antidepressant treatment, PTSD, or MDE and were matched with a randomly selected cohort of 1612 women who did not have the exposures. 2654 women from this cohort had a singleton live birth and were included in this study.

Preterm birth was not significantly associated with women who had only PTSD or only MDE. However, women with PTSD were likely to also experience MDE and when analyzed together, these exposures were associated with a 4-fold increased risk of preterm birth (OR: 4.08, 95% CI: 1.27–13.15). Women with subsyndromal PTSD were also found to have a 3.82 times increased risk for preterm birth when calculated with MDE (95% CI: 1.29–1128). The MPSS is scored on a range from 0 to 110, and each point increase in the score was associated with a 1% to 2% increase in the odds of a preterm birth. Other factors significantly associated with risk of preterm birth were independent of the effect of PTSD and MDE and included a history of previous preterm birth (OR: 4.37; 95% CI: 3.02–6.33), serotonin reuptake inhibitor use (OR: 1.55; 95% CI: 1.02–2.36), and increasing maternal age (OR: 0.62; 95% CI: 0.45–0.85).

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