Studies of Posttraumatic Stress Disorder (PTSD) in pregnant women in public payer
settings typical of Healthy Start (HS) programs have shown rates 5 or more times that of other
populations, and rates as high as 33% of lifetime PTSD sub-threshold symptoms. PTSD during pregnancy has been linked to poor prenatal care and high risk behaviors such as drug and alcohol use and smoking. Further, PTSD may pose a barrier to care as obstetric procedures and pregnancy may trigger PTSD symptoms and avoidance of care. PTSD is also associated with pregnancy and birth complications and negative postpartum outcomes including excessive weight gain, preterm birth, low birth weight, risk for parenting problems, and increased barriers to breastfeeding.
The objectives of this research study are to screen 750 pregnant women at risk of traumarelated stress symptoms, and adapt and test an evidence-based intervention for pregnant women with PTSD and sub-threshold PTSD symptoms served by the MCH-funded HS program in two community health centers. The study will use a prospective experimental design to randomly assign two large HS delivery sites to intervention and usual care conditions, and adapt and implement a psychoeducational program (Seeking Safety) for identified at risk women. Women who screen positive (n=150) will be invited to consent to the study (n=135) which will involve three research data collection interviews (early prenatal, late prenatal-32 weeks, and 1 month postpartum). Intervention women (n= 67) will receive up to 8 sessions specifically designed to develop coping skills for PTSD delivered by HS workers as part of their regular prenatal care meetings with women between study intake and 32-weeks gestation. The ultimate outcome is to improve pregnancy, birth, and postpartum outcomes for women with a trauma history and current symptoms of clinical or sub-threshold PTSD. We expect the proposed research will result in a feasible intervention approach for a large number of pregnant women affected by PTSD.
The proposed study addresses all four of the Strategic Research Issues and priorities of
the Maternal and Child Health Bureau (MCHB). Specifically, it will improve public health
service systems by implementing infrastructure changes in existing prenatal and HS programs to increase screening, treatment and referral for pregnant women who are at great risk for trauma exposure and PTSD symptoms (Strategic Research Issue #1). It addresses barriers to health care access (Strategic Research Issue #2) by treating the trauma-related symptoms that prevent women from completing appropriate prenatal care and increasing trauma informed training for prenatal providers of low income and minority women. This study's focus on capacity building for HS will contribute to quality care for pregnant women with PTSD (Strategic Research Issue #3). Finally, the integrated, trauma-focused approach and skills taught in the Seeking Safety intervention are designed to improve personal safety and healthy development for the mother and unborn child, by promoting coping skills and decreasing risk behaviors (Strategic Research Issue #4). The proposed study is also closely aligned with a newly launched three-year MCHB strategic initiative, "State and Community Resource Development to prevent, Assess, and Provide Interventions Addressing Intimate Partner Violence (IPV) and Postpartum Depression (PPD)."