Adverse pregnancy outcomes and current health status in women with PTSD and SUD.
The co-occurrence of post-traumatic stress disorder (PTSD) with substance use disorder (SUD) is a challenging clinical presentation with a complicated etiologic pathway. Women’s reproductive history, especially adverse reproductive events, may represent an important set of factors predicting current health and health perceptions. In the National Drug Abuse Treatment Clinical Trials Network “Women and Trauma” study (protocol CTN-0015), 353 women (ages 18-65) with co-occurring PTSD and SUD were enrolled into a randomized controlled trial of 12 biweekly group sessions of either Seeking Safety, an integrated SUD/PTSD treatment, or Women’s Health Education. Women were assessed at baseline, 1, 12, 24, and 52 weeks post intervention on measures of perceived health. Researchers sought to characterize reproductive history in these women, and to examine its association with current health problems. Generalized estimating equations (GEE) were employed to account for the repeated health assessments.
Of 328 women providing baseline reproductive history, 93% had ever been pregnant. Of these, 32 (10.5%) reported giving birth to a child who died, 154 (50.5%) reported an abortion, 119 (39%) reported a miscarriage, 13 (4.3%) reported stillbirth, and 71 (23.4%) reported a premature infant who survived. Overall, 206 (62.8%) reported at least one of these events, and 177 (54%) reported at least one other than miscarriage. At follow-up visits, these 177 reported 3.1 more average days of medical problems in the last month, were more trouble by medical problems, were more likely to report that they had been feeling bad lately, and rated current health status more poorly than other women.
Conclusions: These findings suggest that women with a history of adverse reproductive events may be at increased risk for poor perceived health status. Treatment of PTSD and SUD in these women may be improved by consideration of adverse reproductive history.
Related protocols: CTN-0015