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Research Review

Many Women Vets Report Adverse Pregnancy Outcomes, Postpartum Mental Health Problems After Leaving Military Service

PTSD and moral injury increase risk for these outcomes

Women veterans with more symptoms of PTSD or moral injury (guilt, shame, or demoralization in response to participating in or witnessing events that violate one's sense of right and wrong), are at greater risk for negative pregnancy outcomes and postpartum depression in the three years following discharge from military service.

The number of women in the military and associated veteran population continues to grow with the largest increases observed among women of child-bearing age.

More than 9,500 veterans were enrolled in a study approximately three months following their discharge from the service. Every six months they completed surveys which included questions about current pregnancies and outcomes. A total of 318 women veterans experienced a pregnancy in the three years following separation from military service.

The researchers found one in two women veterans (50%) who became pregnant during the study period experienced a negative pregnancy outcome. In addition, the proportion of women who reported experiencing other adverse outcomes were as follows:

• pregnancy outcome percentage;
• postpartum depression or anxiety 30%;
• miscarriage 25%;
• obstetrical medical condition (such as preeclampsia or gestational diabetes) 22%;
• emergency C-section 9%;
• baby to NICU 8%;
• preterm birth 6%;
• stillbirth 2%; and
• ectopic or tubal pregnancy 2%.

According to the researchers, the finding that PTSD and moral injury increase risk for these outcomes suggests that screening for these conditions is important. "Although depression screening has become more common in obstetric settings due to recommendations made by the U.S. Preventative Service Task Force, it is unlikely that screening for PTSD and moral injury are universally being conducted in these settings," explains leas author Yael I. Nillni, PhD, a clinical research psychologist in the National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System and an assistant professor of psychiatry at Boston University School of Medicine.

While screening for PTSD is common in VA medical centers, screening for PTSD in OB/GYN clinics in the community is not a widespread or common practice. "Given that many women veterans currently receive obstetric care outside of the VA, increased awareness of the impact of PTSD and moral injury on perinatal outcomes is imperative to improve screening during this sensitive time and connect at-risk veterans to services."

These findings appear online in the Journal of Traumatic Stress.

Source: Boston University School of Medicine