Posttraumatic Stress Disorder and Risk of Spontaneous Preterm Birth
Posttraumatic Stress Disorder and Risk of Spontaneous Preterm Birth
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DOI：
10.1097/aog.0000000000000542
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发表时间：
2014-12-01
影响因子：
7.2
通讯作者：
Phibbs, Ciaran S.
中科院分区：
文献类型：
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作者：
Shaw, Jonathan G.;Asch, Steven M.;Phibbs, Ciaran S.
目的：评估产前创伤后应激障碍（PTSD）和自发性早产之间的关联。方法：我们在退伍军人健康管理局2000年至2012年覆盖的16，334例分娩的回顾性队列中确定了产前PTSD状态和自发性早产。我们将患有创伤后应激障碍的母亲分为那些在分娩前一年被诊断出患有创伤后应激障碍的母亲（活动性创伤后应激障碍）和那些只有早期诊断的母亲（历史性创伤后应激障碍）。我们确定了自发性早产和潜在的混杂因素，包括年龄，种族，军事部署，双胞胎，高血压，物质使用，抑郁症，和军事性创伤筛查的结果，然后进行多变量回归，估计调整后的比值比（OR）的自发性早产作为一个功能的PTSDstatus.RESULTS：在16,334出生，3,049（19%）的母亲与PTSD诊断，其中1,921（12%）有积极的PTSD。在调整前，活动性PTSD患者（9.2%，n=176）的自发性早产率高于历史性PTSD患者（8.0%，n=90）或无PTSD患者（7.4%，n=982）（P= 0.02）。当调整协变量时，PTSD和早产之间的关联仅在活动性PTSD患者中持续存在（调整OR 1.35，95%置信区间[CI] 1.14-1.61）。调整共病精神和医学诊断的分析显示，与活动性PTSD的关联是robust.CONCLUSION：在这个队列中，包含了前所未有的数量的PTSD影响的怀孕，母亲与活动性PTSD显着更容易遭受自发性早产与归因于两个多余的早产每100分娩（95%CI 1-4）。创伤后应激障碍的健康影响可能会通过出生结果延伸到下一代。证据等级：II
OBJECTIVE:To evaluate the association between antenatal posttraumatic stress disorder (PTSD) and spontaneous preterm delivery.METHODS:We identified antenatal PTSD status and spontaneous preterm delivery in a retrospective cohort of 16,334 deliveries covered by the Veterans Health Administration from 2000 to 2012. We divided mothers with PTSD into those with diagnoses present the year before delivery (active PTSD) and those only with earlier diagnoses (historical PTSD). We identified spontaneous preterm birth and potential confounders including age, race, military deployment, twins, hypertension, substance use, depression, and results of military sexual trauma screening and then performed multivariate regression to estimate adjusted odds ratio (OR) of spontaneous preterm delivery as a function of PTSD status.RESULTS:Of 16,334 births, 3,049 (19%) were to mothers with PTSD diagnoses, of whom 1,921 (12%) had active PTSD. Spontaneous preterm delivery was higher in those with active PTSD (9.2%, n=176) than those with historical (8.0%, n=90) or no PTSD (7.4%, n=982) before adjustment (P=.02). The association between PTSD and preterm birth persisted, when adjusting for covariates, only in those with active PTSD (adjusted OR 1.35, 95% confidence interval [CI] 1.14-1.61). Analyses adjusting for comorbid psychiatric and medical diagnoses revealed the association with active PTSD to be robust.CONCLUSION:In this cohort, containing an unprecedented number of PTSD-affected pregnancies, mothers with active PTSD were significantly more likely to suffer spontaneous preterm birth with an attributable two excess preterm births per 100 deliveries (95% CI 1-4). Posttraumatic stress disorder's health effects may extend, through birth outcomes, into the next generation.LEVEL OF EVIDENCE:II