Trends and adverse pregnancy outcomes associated with post-traumatic stress disorder: a population-based study of delivery hospitalisations

Abstract Purpose This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs. Methods This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively. Results PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p < 0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08–1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01–1.17, p = 0.03). Longer hospital stays and higher costs were also observed among women with PTSD. Conclusion These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.