Evaluating Posttraumatic Stress as a Predictor of Substance Use among Pregnant and Postpartum Women in Residential Treatment: A Latent Class Analysis

Substance use among pregnant and postpartum women (PPW) can lead to damaging outcomes for themselves (i.e., spontaneous abortion, mortality, and morbidity), and for their fetus/child(ren) (i.e., developmental problems for the child, child protective services involvement, or maternal incarceration resulting in the child(ren) in custody of the state). With limited research on subgroups of women with substance use issues, and a dearth of literature on subgroups of users that are PPW, there is little information to identify associated characteristics (i.e., posttraumatic stress) to inform treatment recommendations. A latent class analysis was conducted in order to evaluate the patterns of recent substance use among PPW entering residential treatment for substance use disorders (N = 271). Additionally, differences among the classes were examined on posttraumatic stress and other sociodemographics. Three classes were identified: methamphetamine + tobacco (22%), polysubstance use (32%), and tobacco only/minimal use (46%). There were no significant differences found among the classes with posttraumatic stress symptom severity, social support, referral source, education level, or pregnancy status. There were differences on race/ethnicity, probable PTSD diagnosis, and the hyperarousal symptom cluster of PTSD. While the largest class was the tobacco only/minimal use class, it is not indicative of a minimal risk class, considering the associated negative health outcomes with tobacco. Further, findings showed a particularly vulnerable subgroup of PPW in the polysubstance use class that were more likely to identify as African American or black, meet the criteria for a probable PTSD diagnosis, and have higher hyperarousal symptoms of PTSD.