16: Impact of severe stress after a major natural disaster on perinatal outcomes

Abstract

Hurricane Harvey displaced over 60,000 of Houston’s nearly 4.5 million residents. Natural disasters have been linked to posttraumatic stress disorders. Our objective was to evaluate the impact on perinatal outcomes of self-perceived stress among pregnant women in the weeks to months following Hurricane Harvey. Data was abstracted from our perinatal research database (PeriBank). An abbreviated version of the PTSD checklist – civilian version (PCL-C), a validated tool for evaluating both pregnant women and development of PTSD, was prospectively administered to women delivering within our network. Severe stress was defined as either a score >6 in her overall stress score (1-10) or a positive response for symptomatic stress on PCL-C. Composite maternal morbidity (CMM) included: preeclampsia/GHTN, chorioamnionitis, endometritis, blood transfusion, peripartum hysterectomy, maternal ICU admission, pulmonary edema or maternal death. Composite neonatal morbidity (CNM) included: 5-minute Apgar score ≤ 3 at 5 minutes, respiratory distress syndrome (RDS), use of ventilator/CPAP, newborn sepsis, seizure, stillbirth, or neonatal death. Odds ratios were corrected for possible confounders revealed during univariate analysis. Neonatal outcomes were corrected for gender and GA delivery. Of 2,121, 456 (22%) pregnant women delivering after Hurricane Harvey responded to our questionnaire with most suffering the storm effects during their second trimester (84%). Severe stress was diagnosed in 226 (49.6%) with only 3.1% seeking professional mental health services. Women reporting self-perceived severe stress were older and more likely to be married. These women were more likely to suffer sleeplessness (2.1 vs 12.4%, p<0.01), anxiety (9.2 vs. 18.1%, p<0.01), panic symptoms (2.2 vs. 7.5%, p<0.01) and hopelessness (2.2 vs. 7.5%, p<0.01) during the 4 weeks after the hurricane made landfall. They were also more likely to report having financial difficulty after the natural disaster (30.4% vs. 40.7%, p=0.03). Interestingly, the rates of perinatal outcomes were similar between both groups (Table) and did not vary by trimester of pregnancy in which stress occurred. Positive responses to individual PCL-C questions were unable to identify women at risk for adverse perinatal outcomes (figure). Women reporting levels of severe stress following Hurricane Harvey had similar perinatal outcomes compared to women not reporting severe stress.View Large Image Figure ViewerDownload Hi-res image Download (PPT)