pregnant women PTSD

Pregnant women with PTSD have higher levels of stress hormone cortisol

December 5, 2017

Science Daily/University of Michigan

A woman's emotional and physical health during pregnancy impacts a developing fetus, research shows. However, less is known about the effect of past stressors and posttraumatic stress disorder on an expectant woman.

 

To that end, researchers at the University of Michigan measured the stress hormone cortisol in pregnant women from early pregnancy to when their baby was 6 weeks old. They found that those with a dissociative type of PTSD that's often related to childhood abuse or trauma had levels up to 10 times higher than their peers.

 

These toxic levels of cortisol may contribute to health problems in the next generation, said Julia Seng, professor of nursing and lead author on the study.

 

"We know from research on the developmental origins of health and disease that the baby's first environment in its mother's body has implications for health across the lifespan," Seng said. "Higher exposure to cortisol may signal the fetus to adapt in ways that help survival, but don't help health and longevity. This finding is very useful because it helps us know which women are most likely to exhibit the highest level of stress and stress hormones during pregnancy and postpartum."

 

Cortisol is sometimes called the stress hormone because it's released in stressful situations as part of the flight-or-fight response. Cortisol levels that stay high are linked to serious health problems such as heart disease and high blood pressure, and can fuel weight gain, depression and anxiety plus a host of other problems. The effect of elevated cortisol on a developing fetus isn't well understood, but high cortisol and stress also contribute to preterm birth

 

In the study, 395 women expecting their first child were divided into four groups: those without trauma, those with a trauma but no PTSD, those with classic PTSD and those with dissociative PTSD.

 

Researchers measured salivary cortisol at different times during the day. Then 111 of those women gave saliva specimens until postpartum. The difference in cortisol was greatest in early pregnancy, when levels were eight times higher in the afternoon and 10 times higher at bedtime for the dissociative group than for other women.

 

About 8 percent of pregnant women in the study had PTSD, a disorder that results when symptoms of anxiety and fear persist well after exposure to stressful events. About 14 percent of that group had the more complex dissociative PTSD, which was associated with higher cortisol.

 

"It's been a mystery in our field why cortisol is sometimes high with PTSD and sometimes not," Seng said. "This finding that in pregnancy it's only the dissociative subgroup that has high cortisol gives us more to go on for future research."

 

Seng was surprised at how high the cortisol was in the dissociative group. She also said researchers expected women with classic PTSD to experience elevated cortisol as well, and the fact that they didn't is good news.

 

"We can do something for the 1-to-2 out of 100 pregnant women who have this dissociative PTSD," Seng said. "We can work with them to make pregnancy, maternity care, labor, breastfeeding and early parenting less likely to trigger stress reactions. And we can connect them to mental health services when they are ready to treat their PTSD."

 

Seng and collaborator Mickey Sperlich have developed a PTSD-specific education program for pregnant woman with a childhood trauma called the Survivor Moms' Companion, which has been piloted in Michigan and is currently being piloted in England.

https://www.sciencedaily.com/releases/2017/12/171205130121.htm

Pregnant women with PTSD more likely to give birth prematurely

- November 6, 2014

Science Daily/Stanford University Medical Center

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study has found. The study, which examined more than 16,000 births to female veterans, is the largest ever to evaluate connections between PTSD and preterm birth.

 

Having PTSD in the year before delivery increased a woman's risk of spontaneous premature delivery by 35 percent, the research showed. The results will be published online Nov. 6 in Obstetrics & Gynecology.

 

"This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery," said the study's senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University. "Mothers with PTSD should be treated as having high-risk pregnancies."

 

Spontaneous preterm births, in which the mother goes into labor and delivers more than three weeks early, account for about six deliveries per 100 in the general population. This means that the risk imposed by PTSD translates into a total of about two additional premature babies for every 100 births. In total, about 12 babies per 100 arrive prematurely; some are born early because of medical problems for the mother or baby, rather than because of spontaneous labor.

 

The effect of stress

 In other words, although pregnant women with PTSD may have other health problems or behave in risky ways, it's the PTSD that counts for triggering labor early.

 

"The mechanism is biologic," Phibbs said. "Stress is setting off biologic pathways that are inducing preterm labor. It's not the other psychiatric conditions or risky behaviors that are driving it."

 

However, if a woman had been diagnosed with PTSD in the past but had not experienced the disorder in the year before giving birth, her risk of delivering early was no higher than it was for women without PTSD. "This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down," said Phibbs, adding that the idea needs to be tested.

 

Although PTSD is more common in military veterans than the general population, a fairly substantial number of civilian women also experience PTSD, Phibbs noted. "It's not unique to the VA or to combat," he said, noting that half of the women in the study who had PTSD had never been deployed to a combat zone. "This is relevant to all of obstetrics."

 

The VA has already incorporated the study's findings into care for pregnant women by instructing each VA medical center to treat pregnancies among women with recent PTSD as high-risk. And Phibbs' team is now investigating whether PTSD may also contribute to the risk of the mother or baby being diagnosed with a condition that causes doctors to recommend early delivery for health reasons.

http://www.sciencedaily.com/releases/2014/11/141106173639.htm

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