How Do Trauma and PTSD Affect Pregnancy Health Risks?

What you need to know

Exposure to trauma and PTSD may increase risks for pregnancy complications like gestational diabetes and high blood pressure
These risks appear to be higher for women of color, contributing to racial disparities in pregnancy health
More research is needed to understand the biological mechanisms and develop targeted interventions

How trauma and stress affect the body

When a person experiences trauma or chronic stress, it triggers changes in several of the body’s key systems:

The autonomic nervous system

The autonomic nervous system controls many of our automatic bodily functions like heart rate and digestion. It has two main parts:

The sympathetic nervous system, which activates our “fight or flight” response
The parasympathetic nervous system, which helps us relax and recover

Trauma and chronic stress can cause the sympathetic system to be overactive. This leads to:

Increased heart rate
Higher blood pressure
Reduced heart rate variability (less flexibility in heart rhythms)

These changes are linked to higher risks for conditions like diabetes and high blood pressure.

The HPA axis

The hypothalamic-pituitary-adrenal (HPA) axis is the body’s central stress response system. It controls the release of stress hormones like cortisol.

Trauma and chronic stress can disrupt normal HPA axis function, leading to:

Elevated cortisol levels
Increased glucose production
Insulin resistance
Changes in appetite regulation

Over time, these disruptions can increase risks for metabolic disorders.

Inflammation

The nervous system and HPA axis changes caused by trauma and stress can trigger increased inflammation throughout the body. Chronic inflammation is linked to many health problems, including cardiovascular disease and diabetes.

Pregnancy changes and health risks

Pregnancy itself causes major changes in a woman’s body, including:

Reduced heart rate variability
Increased cortisol production
Higher blood sugar levels
Changes in immune system function

While these changes are normal, they can put extra stress on the body. For some women, especially those with a history of trauma or PTSD, the added stress of pregnancy may increase risks for complications.

Gestational diabetes

Gestational diabetes is high blood sugar that develops during pregnancy. It affects about 5-10% of pregnant women in the U.S.

Several studies have found links between trauma, PTSD, and increased risk of gestational diabetes:

In a large study of pregnant veterans, those with current PTSD had higher rates of gestational diabetes
Women who experienced severe physical abuse in childhood had 30-40% higher risk of gestational diabetes
Higher levels of perceived stress during pregnancy were associated with increased odds of gestational diabetes

However, not all studies have found a clear link. More research is needed to understand the relationship.

Low birth weight and fetal growth restriction

Low birth weight refers to babies born weighing less than 5.5 pounds. Fetal growth restriction means the baby is smaller than expected for its gestational age.

Research has found some connections between trauma/PTSD and low birth weight:

Women who experienced racism in childhood were more likely to have low birth weight babies
High lifetime trauma exposure was linked to lower birth weights, especially for male infants
PTSD diagnosis was associated with higher rates of low birth weight in several studies

However, most studies did not find a link between trauma/PTSD and fetal growth restriction. The effects seem to be mainly on overall birth weight rather than restricted growth.

High blood pressure in pregnancy

High blood pressure that develops during pregnancy is called gestational hypertension. A more severe form called preeclampsia can be dangerous for both mother and baby.

Studies have found some links between trauma/PTSD and high blood pressure in pregnancy:

PTSD diagnosis was associated with higher rates of both gestational hypertension and preeclampsia in pregnant veterans
Women who experienced intimate partner violence and had PTSD symptoms were at higher risk for hypertension and preeclampsia
Higher lifetime stress exposure was linked to increased risk of hypertensive disorders of pregnancy

However, childhood trauma exposure alone was not associated with higher blood pressure risks in most studies. The effects seem to be mainly related to PTSD and ongoing stress.

Racial disparities in pregnancy health risks

An important finding across many studies was that women of color, especially Black and Hispanic women, face higher risks for pregnancy complications. This appears to be true even when controlling for other risk factors.

Some key disparities:

Asian and Hispanic women have higher rates of gestational diabetes
Black and Hispanic women have higher rates of hypertensive disorders of pregnancy
Black women have higher rates of low birth weight babies

Researchers believe trauma and chronic stress related to racism and discrimination may contribute to these disparities. Women of color are more likely to experience traumatic events and develop PTSD. The added physiological stress may increase pregnancy health risks.

However, more research is needed to fully understand the connections between trauma, stress, race, and pregnancy outcomes. Most existing studies have not had large or diverse enough samples to draw firm conclusions.

Limitations of current research

While the studies reviewed suggest links between trauma/PTSD and pregnancy complications, there are some important limitations to keep in mind:

Many studies did not control for key risk factors like family history, pre-existing conditions, diet, and exercise
Different studies used different methods to assess trauma and PTSD, making it hard to compare results
Most studies had limited racial/ethnic diversity in their samples
Few studies looked at biological markers of stress during pregnancy
More research is needed on how different types of trauma may have different effects

Conclusions

Trauma exposure and PTSD appear to increase risks for some pregnancy complications, especially gestational diabetes and high blood pressure
These risks seem to be higher for women of color, potentially contributing to racial disparities in maternal health
The physiological effects of chronic stress on the body’s key systems likely play a role, but more research is needed
Understanding these connections could help identify high-risk pregnancies earlier and develop targeted interventions
More diverse, large-scale studies are needed to clarify the relationships between trauma, stress, race, and pregnancy health

Pregnancy can be a vulnerable time for women who have experienced trauma or have PTSD. While more research is still needed, being aware of the potential increased health risks is important. Pregnant women with a history of trauma should discuss any concerns with their healthcare providers. With proper monitoring and support, many pregnancy complications can be prevented or managed effectively.