Describing Adverse Pregnancy Events and Pregnancy-Associated Death Among Veterans

Area of Science:

• Reproductive Health
• Health Disparities
• Veteran Health

Background:

• Veterans utilizing VA pregnancy benefits may be at elevated risk for adverse pregnancy outcomes.
• Limited data exists on the incidence of adverse pregnancy events and pregnancy-associated mortality among Veterans.
• Understanding these risks is crucial for improving maternal and infant health within the Veteran population.

Purpose of the Study:

• To determine the rates of adverse pregnancy events and pregnancy-associated mortality among Veterans using VA pregnancy benefits.
• To compare the prevalence of adverse pregnancy events across different racial and ethnic groups of Veterans.
• To identify potential disparities in maternal health outcomes within the Veteran population.

Main Methods:

• Retrospective cohort study utilizing VA national administrative data.
• Inclusion criteria: Veterans aged 18-45 with a pregnancy outcome between October 2009 and September 2016, and a VA primary care visit within one year prior to pregnancy.
• Adverse events and all-cause mortality were identified during pregnancy and up to one year postpartum; logistic regression was used for racial/ethnic comparisons.

Main Results:

• High overall rates of adverse pregnancy events and pregnancy-associated death were observed among Veterans.
• Pregnancies among Black Veterans showed 69% higher odds of any adverse event compared to White Veterans (aOR = 1.69).
• The estimated pregnancy-associated mortality rate was 76 deaths per 100,000 live births.

Conclusions:

• Veterans using VA pregnancy benefits experience significant rates of adverse pregnancy outcomes and mortality.
• Stark racial disparities exist, with Black Veterans facing disproportionately higher risks, mirroring trends in non-VA populations.
• Targeted interventions are needed to address these disparities and improve maternal health for all Veterans.