Screening for PTSD in prenatal care in high risk populations: Importance for identification and service provision to promote healthy pregnancy outcomes

Background: PTSD during pregnancy has been linked to drug and alcohol use, smoking, poor prenatal care and excessive weight gain, preterm birth, low birth weight, ectopic pregnancy and other problems. Women with a history of abuse are at risk for parenting problems and increased barriers to breastfeeding. For those who have experienced sexual abuse, obstetric procedures and pregnancy may trigger PTSD symptoms and avoidance of prenatal care. However, screening and treatment for trauma-related stress symptoms in this population within obstetrical care settings is rare, and there is little data on prevalence.

Method: Two prenatal care programs located within community health centers participated in a pilot study to test the feasibility and effectiveness of screening for PTSD using the PC-PTSD, a four question screen with a yes/no response format that asks about symptoms without asking about specific traumas. Those who answer “yes” to at least two of the four questions are considered to have clinical or sub-threshold symptoms of PTSD.

Results: Of 164 pregnant women screened in a 5 month period (7% Asian, 23% Black, 51% Hispanic, 15% White, and 3% other) 33 (23%) screened positive for PTSD symptoms. This rate is double the rate found in studies of commercially insured populations.

Conclusions: Given the high risk of PTSD for pregnancy outcomes, and the increased prevalence in these ethnically and economically diverse community health center prenatal settings, a simple tool to screen for PTSD, along with referrals to appropriate services may greatly improve prenatal and postpartum health.