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military ptsdData on post-traumatic stress disorder (PTSD) in women military personnel was evaluated at the Veterans Administration to determine the association between PTSD within 1 year of delivery and risk or a history of a prior diagnosis of PTSD and the risk of preterm birth.

In more than 16,000 deliveries, 19% were in women with PTSD including 12% with active PTSD. The risk for spontaneous preterm delivery was higher among women with active PTSD (9%) than those with a history of PTSD (8%) or those with no PTSD (7%). The majority of the women with active PTSD had experienced sexual trauma while in the military as well as depression disorders.

In a separate study of prenatal stress, researchers randomized 64, low income, pregnant urban black women who entered the study at 16-21 weeks of their pregnancy to receive either a supplement of 450 mg of docosahexaenoic acid (DHA) or placebo until their delivery. At 30 weeks gestation, those who were in the DHA group had a lower perception of stress than those in the placebo group. Those who received DHA also had lower cortisol output in response to arriving at the research facility and a better ability to modulate their response to a social stress test.

Commentary: I have to say that the aspect of these two studies that was the most striking was the high prevalence of sexual trauma experienced by women while in the military. Moving beyond that, both of these studies highlight the important impact of maternal stress and maternal well-being on birth outcomes. This study also highlights the potential of DHA in improving the maternal response to stress during pregnancy, yet one more reason for the importance of supplementing with fish oil during pregnancy. Clinicians should also conclude the importance of inquiring about traumatic experiences past and present and employ strategies to help manage trauma and stress.

References

Shaw J, et al. Posttraumatic stress disorder and risk of spontaneous preterm birth. Obstet Gynecol 2014 Dec ;124:1111

Keenan K, et al. Association between fatty acid supplementation and prenatal stress in African Americans. A randomized controlled trial. Obstet Gunecol 2014 Dec; 124:1080

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