Study: Pregnant women with PTSD more likely to give birth early

A study found that pregnant women with PTSD are more likely to give birth early.

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study from the Stanford University School of Medicine and the U.S. Department of Veterans' Affairs 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.

A piece of the prematurity puzzle

"Spontaneous preterm labor has been an intractable problem," said Phibbs, noting that rates of spontaneous early labor have barely budged in the last 50 years. "Before we can come up with ways to prevent it, we need to have a better understanding of what the causes are. This is one piece of the puzzle."

Doctors want to prevent prematurity because of its serious consequences. Premature babies often need long hospitalizations after birth. They are more likely than full-term babies to die in infancy. Many of those who survive face lasting developmental delays or long-term impairments to their eyesight, hearing, breathing or digestive function.

Phibbs' team analyzed all deliveries covered by the Veterans Health Administration from 2000 to 2012, a total of 16,344 births. They found that 3,049 infants were born to women with PTSD diagnoses. Of these, 1,921 births were to women with "active" PTSD, meaning the condition was diagnosed in the year prior to giving birth, a time frame that the researchers thought could plausibly affect pregnancy.

The researchers examined the effects of several possible confounding factors. Being older, being African-American or carrying twins all increased the risk of prematurity, as extensive prior research has shown.

The researchers also looked at the effects of maternal health problems (high blood pressure, diabetes and asthma); possible sources of trauma (deployment and military sexual trauma); mental health disorders other than PTSD; drug or alcohol abuse; and tobacco dependence. However, these factors had little influence on risk for premature birth.

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.

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New mothers sleepy for many months

A study from Australia shows that new mothers are still very sleepy four months after giving birth and should be cautious about returning to work too quickly.

New mothers are being urged to be cautious about returning to work too quickly, after a study found one in two were still excessively sleepy four months after giving birth.

Dr Ashleigh Filtness, from QUT's Centre for Accident Research & Road Safety -- Queensland (CARRS-Q), studied the sleep patterns and tiredness of postpartum mums and found despite new mums recording stable night sleep times at 18 weeks, they continued to report being excessively tired.

The CARRS-Q study, published in PLoS One, followed 33 healthy new mums who recorded their postpartum sleep patterns in 15 minute increments during weeks 6, 12 and 18.

"Sleep disruption strongly influences daytime function, with sleepiness recognized as a risk-factor for people performing critical and dangerous tasks," she said.

Dr Filtness said the study had significant implications for decisions-makers about when women should return to work, with current government paid parental leave entitlements ceasing at 18 weeks.

"This brings into question whether four months parental leave is sufficient to ensure daytime sleepiness has diminished to a manageable level before returning to work," she said.

"It is important when developing regulations for parental leave entitlements that policy makers take into account the high prevalence of excessive daytime sleepiness experienced by new mothers.

"With the birth of every baby the new mother must adjust to the demands of parenting and one aspect of that is to remain functional while experiencing potentially severe sleep disruption.

"To put this into context, the assessment tool used to determine new mums' sleepiness is also used by GPs to determine clinically relevant levels of sleepiness.

"If any other otherwise healthy person presented to a doctor with this degree of sleepiness they would likely have been offered advice regarding implications for daytime impairment including the impact on sustaining attention and decision making."

Dr Filtness said the study also found while new mums were still waking on average twice a night to attend to their babies at 6, 12 and 18 weeks -- their total sleep time was about 7 hours and 20 minutes.

She said Australian new mothers actually slept more than the average American worker (6h 53mins).

"So while postpartum women experienced disturbed sleep, they didn't necessarily experience total reduced sleep time," she said.

"What we found was that inevitably, new mothers will wake in the night to attend to their infant and the number of times they wake remains consistent during the first 18 postpartum weeks.

"Sleep disruption reduced over time and it appears this was driven by a reduction in the time it took for new mums to return to sleep, suggesting improved efficiency by mothers at settling their infant or the development of the infant's circadian rhythm.

"These findings highlight the importance of sleep quality as opposed to sleep quantity, especially during the first 12 weeks."

"Soon-to-be mums should be aware of the importance of their own sleep and consider how they are going to preserve their own sleep during the first few months of caring for a baby," she said.

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Study: Sleep apnea can raise risk of death during pregnancy

A study found that women with sleep apnea have a higher risk of dying during pregnancy than women without sleep apnea.

The risk of dying in the hospital is more than five times higher for pregnant women with obstructive sleep apnea than for those without the sleep disorder, a new study suggests.

People with sleep apnea experience repeated, brief interruptions in their breathing during sleep.

The University of South Florida study authors also found that sleep apnea is associated with higher rates of serious medical conditions that are the leading causes of pregnancy- and childbirth-related death, including an enlarged heart, blood clots in the lungs, and the dangerous blood pressure conditions known as preeclampsia and eclampsia.

The team analyzed data from an estimated 55 million women who were pregnant or gave birth in U.S. hospitals between 1998 and 2009. The study was published online May 1 in the journal Sleep.

"The astounding association with maternal death was surprising," lead author Dr. Judette Louis, assistant professor of obstetrics and gynecology, said in a university news release. "I did not expect to find such a difference in mortality between pregnant women who had sleep apnea and those who did not, especially when we controlled for obesity and other complicating factors."

The increased risk of death may be due to the added stress that sleep apnea places on the normal physical demands of pregnancy, she said.

However, although the study found an association between sleep apnea and an increased risk of pregnancy-related death, it did not prove a cause-and-effect relationship.

The researchers noted that maternal death rates in the United States have increased in recent years, and a rising obesity rate is one suspected cause.

"Our study indicates that sleep apnea may also play a role, whether a woman is obese or not," Louis said. "It's important for obstetricians and primary care practitioners to identify sleep apnea in younger women of reproductive age, convey its risk, and treat the condition before pregnancy."

Previous, smaller studies have found that sleep apnea increases the risk for problems during pregnancy, but this is the first large-scale analysis linking sleep apnea with increased risk of maternal death.

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Study claims no link between autism and induced labor

A study revealed that there is no link between autism and induced labor.

There is no connection between inducing labor in childbirth and autism, according to a new statement released Monday by the American College of Obstetricians and Gynecologists.

Existing guidelines on when and how labor should be induced or accelerated should not be changed, because limiting labor inductions could have negative effects on the health of women and their babies, ACOG's committee on obstetric practice recommended in a "committee opinion."

Although some studies have suggested there may be a link between autism and the use of oxytocin to induce or speed up labor, this research has significant limitations, according to an ACOG news release. The studies were small, inconsistent and retrospective, the opinion said, and limited comparison groups meant certain factors might not have been accounted for.

The committee concluded there is no evidence to prove that labor induction causes autism.

The group also cautioned that any reduction in labor induction would "almost certainly" have a negative effect on patient care, and likely result in more cesarean deliveries.

"In obstetric practice, labor induction and augmentation play an essential role in protecting the health of some mothers and in promoting safe delivery of many babies," Dr. Jeffrey Ecker, committee chair, said in the news release.

"When compared with these benefits, the research we reviewed in assembling this committee opinion, relative to the utilization of oxytocin, had clear limitations," Ecker said. "Because of this, these studies should not impact how obstetricians already safely and effectively use labor induction and augmentation when caring for their patients."

The committee's opinion was endorsed by the Society for Maternal-Fetal Medicine. The findings were published in the May issue of Obstetrics & Gynecology.

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