{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T13:14:12Z","timestamp":1788095652613,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,3,22]],"date-time":"2017-03-22T00:00:00Z","timestamp":1490140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Paediatric Perinatal Epid"],"published-print":{"date-parts":[[2017,5]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Prior work shows that Post\u2010traumatic Stress Disorder (PTSD<\/jats:styled-content>) predicts an increased risk of preterm birth, but the causal pathway(s) are uncertain. We evaluate the associations between PTSD<\/jats:styled-content> and antepartum complications to explore how PTSD<\/jats:styled-content>'s pathophysiology impacts pregnancy.<\/jats:p><\/jats:sec>Methods<\/jats:title>This retrospective cohort analysis of all Veterans Health Administration (VA<\/jats:styled-content>)\u2010covered deliveries from 2000\u201312 used the data of VA<\/jats:styled-content> clinical and administration. Mothers with current PTSD<\/jats:styled-content> were identified using the ICD<\/jats:styled-content>\u20109 diagnostic codes (i.e. code present during the antepartum year), as were those with historical PTSD<\/jats:styled-content>. Medical and administrative data were used to identify the relevant obstetric diagnoses, demographics and health, and military deployment history. We used Poisson regression with robust error variance to derive the adjusted relative risk estimates (RR<\/jats:styled-content>) for the association of PTSD<\/jats:styled-content> with five clinically relevant antepartum complications [gestational diabetes (GDM<\/jats:styled-content>), preeclampsia, gestational hypertension, growth restriction, and abruption]. Secondary outcomes included proxies for obstetric complexity (repeat hospitalisation, prolonged delivery hospitalisation, and caesarean delivery).<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 15 986 singleton deliveries, 2977 (19%) were in mothers with PTSD<\/jats:styled-content> diagnoses (1880 (12%) current PTSD<\/jats:styled-content>). Mothers with the complication GDM were 4.9% and those with preeclampsia were 4.6% of all births. After adjustment, a current PTSD<\/jats:styled-content> diagnosis (reference = no PTSD<\/jats:styled-content>) was associated with an increased risk of GDM<\/jats:styled-content> (RR<\/jats:styled-content> 1.4, 95% confidence interval (CI<\/jats:styled-content>) 1.2, 1.7) and preeclampsia (RR<\/jats:styled-content> 1.3, 95% CI<\/jats:styled-content> 1.1, 1.6). PTSD<\/jats:styled-content> also predicted prolonged (>4 day) delivery hospitalisation (RR<\/jats:styled-content> 1.2, 95% CI<\/jats:styled-content> 1.01, 1.4), and repeat hospitalisations (RR<\/jats:styled-content> 1.4, 95% CI<\/jats:styled-content> 1.2, 1.6), but not caesarean delivery.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The observed association of PTSD<\/jats:styled-content> with GDM<\/jats:styled-content> and preeclampsia is consistent with our nascent understanding of PTSD<\/jats:styled-content> as a disruptor of neuroendocrine and cardiovascular health.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ppe.12349","type":"journal-article","created":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T10:25:39Z","timestamp":1490264739000},"page":"185-194","source":"Crossref","is-referenced-by-count":77,"title":["Post\u2010traumatic Stress Disorder and Antepartum Complications: a Novel Risk Factor for Gestational Diabetes and Preeclampsia"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7884-3604","authenticated-orcid":false,"given":"Jonathan G.","family":"Shaw","sequence":"first","affiliation":[{"name":"HSR&D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Department of Medicine Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Asch","sequence":"additional","affiliation":[{"name":"HSR&D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Department of Medicine Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodie G.","family":"Katon","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System HSR&D Center of Innovation for Veteran\u2010Centered and Value Driven Care Seattle WA"},{"name":"Department of Health Services University of Washington School of Public Health Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate A.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynaecology Stanford University School of Medicine Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kimerling","sequence":"additional","affiliation":[{"name":"HSR&D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"National Center for Post\u2010traumatic Stress Disorder US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Frayne","sequence":"additional","affiliation":[{"name":"HSR&D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Department of Medicine Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciaran S.","family":"Phibbs","sequence":"additional","affiliation":[{"name":"HSR&D Center for Innovation to Implementation (Ci2i) US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Health Economics Resource Center US Department of Veterans Affairs VA Palo Alto Health Care System Palo Alto CA"},{"name":"Department of Pediatrics Division of Neonatal and Developmental Medicine Stanford University School of Medicine Stanford 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