Posttraumatic stress and prenatal care adequacy among Black/African American women

Abstract

Black/African American women with trauma histories experience a disproportionate burden of adverse perinatal outcomes. One mechanism for this association is inadequate prenatal care, as avoidant symptoms are a hallmark of posttraumatic stress disorder (PTSD). The objective of this study is to examine the association between PTSD symptoms and adequacy of prenatal care among Black/African American women. This retrospective cohort study included all pregnant women who self-identified as Black/African American and were referred to a hospital’s integrated mental health program between 2017-2021. All participants completed a PTSD Checklist -Civilian Version (PCL-C) as a part of an initial mental health evaluation. The EHR was reviewed to codify adequacy of prenatal care, which was assessed in three ways: late initiation of prenatal care (defined as gestational age at the first prenatal visit > 12 weeks), the ratio of no-show to attended prenatal visits, and the Adequacy of Prenatal Care Utilization (APNCU) Index. Bivariable analyses were performed. A propensity score for a positive PTSD screen was generated using confounders generated from a directed acyclic graph. This propensity score was included in multivariable models to control for imbalance across the exposure. Of the 111 women who met inclusion criteria, 57 (51%) screened positive on the PCL-C. Sample characteristics, stratified by a positive screen, are shown in Table 1. PCL-C score was associated with late initiation of prenatal care, the ratio of no-show to attended prenatal visits, and non-adequate prenatal care defined by the APNCU index (Table 2). The associations between late initiation of care and non-adequate APNCU index persisted in multivariable analyses. In this sample of pregnant Black/African American women with an identified mental health condition, PTSD symptoms were associated with inadequate prenatal care. The high prevalence of PTSD symptoms and the association with prenatal care emphasizes the importance of future research focused on trauma-related interventions for Black/African-American women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)