Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans

UMMS Affiliation

Department of Psychiatry, Division of Addiction; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Maternal and Child Health | Military and Veterans Studies | Substance Abuse and Addiction | Women's Health


OBJECTIVES: Maternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse.

METHODS: Data were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth during the interview. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records.

RESULTS: Models testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C score during the postpartum phase.

CONCLUSIONS: PTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.

DOI of Published Version



Holzhauer CG, Kroll-Desrosiers A, Kinney RL, Copeland LA, Bastian LA, Mattocks KM. Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans. Womens Health Issues. 2021 Nov-Dec;31(6):596-602. doi: 10.1016/j.whi.2021.05.002. Epub 2021 Jun 18. PMID: 34148828. Link to article on publisher's site

Journal/Book/Conference Title

Women's health issues : official publication of the Jacobs Institute of Women's Health

PubMed ID


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Link to Article in PubMed