Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Bournissen, Garcia-Facundo

2nd Supervisor

Campbell, Karen M.

Abstract

A particular condition for which there is a dearth of pregnancy information is Post-Traumatic Stress disorder (PTSD). This thesis aimed to evaluate PTSD exposure and treatment in pregnancy. Our first study was a systematic review, meta-analysis, and GRADE assessment that reported associations between maternal PTSD exposure with pregnancy, obstetric, and neonatal outcomes. Our second study was a prospective evaluation of pregnancy outcomes after prazosin exposure in the first trimester of pregnant patients who were counselled at the Fetal Risk Assessment from Maternal Exposures (FRAME) clinic. Our review and analysis found positive associations between PTSD in pregnancy and some adverse pregnancy outcomes including conflicting evidence suggestive that maternal PTSD was associated with increased odds of having a low birthweight infant and preterm birth. Our prospective study found that pregnancy outcomes after prazosin exposure appeared to align with unexposed pregnancy outcomes. Together, these findings contribute to providing information to improve perinatal and neonatal health

Keywords: Post-traumatic stress disorder (PTSD), pregnancy, fetal risk assessment from maternal exposures (FRAME), prazosin, perinatal health, neonatal health.

Summary for Lay Audience

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that usually results after exposure to a traumatic event. It is well-documented that females are more likely to develop PTSD than males. This motivates studying PTSD in pregnant populations. PTSD exposure in pregnancy may have adverse effects on perinatal and neonatal health. Some medications, such as prazosin, are effective in treating PTSD. To date, there is limited research on how PTSD exposure affects perinatal and neonatal health, as well as very limited research on prazosin safety when used during pregnancy. This limit in research limits lowers the quality of care that pregnant patients receive. Therefore, it is important to address the lack of research so that pregnant patients can receive a better level of care throughout their pregnancies. We conducted a systematic review, meta-analysis and GRADE assessment on studies that assessed associations between maternal PTSD with adverse pregnancy, obstetric or neonatal outcomes. Our review found that maternal PTSD was positively associated with infant head circumference, infant sleeping & eating difficulties, reduced breastfeeding, and lower infant salivary cortisol levels. We also found that PTSD exposure in pregnancy may be associated with increased odds of having a preterm birth or a low birthweight infant. We also evaluated fetal and pregnancy outcomes in a sample of pregnant patients exposed to prazosin during the first trimester of their pregnancies. We found that pregnancy and fetal outcomes were consistent with normal pregnant populations that did not have prazosin exposure. In conclusion, PTSD exposure in pregnancy was associated with specific adverse pregnancy, obstetric and neonatal outcomes whereas prazosin exposure in a small number of pregnancies did not demonstrate any adverse pregnancy, obstetric or neonatal outcomes. We expect that the information obtained will help provide guidance on PTSD exposure in pregnancy and on the safety of prazosin exposures in early pregnancy for healthcare providers to better care for pregnant patients. We expect that our findings will contribute to better standards of care in perinatal and neonatal health. Future research should examine the effects of untreated PTSD in pregnancy and examine the effects of prazosin treatment in pregnancy to allow for more official conclusions and to help fill the gaps that currently exist on this topic.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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