Describing Adverse Pregnancy Events and Pregnancy-Associated Death Among Veterans

Background: Veterans who use VA pregnancy benefits may be at high risk for adverse pregnancy outcomes; however, little is known about rates of adverse pregnancy events or pregnancy-associated death among Veterans. Methods: We conducted a retrospective cohort study using VA national administrative data for Veterans ages 18-45 with at least one pregnancy outcome between October 2009 and September 2016 and a VA primary care visit within one year prior to pregnancy. We identified adverse events during pregnancy and up to 42 days after pregnancy and all-cause mortality within one year of pregnancy and compared prevalence of adverse events by Veteran race/ethnicity using adjusted logistic regression. Results: Pregnancies among Black Veterans had 69% higher odds of any adverse event than those among White Veterans (aOR = 1.69, 95% CI: 1.43, 2.00). All-cause mortality during pregnancy or within one year of pregnancy was recorded for 18 pregnancies, resulting in an estimated overall pregnancy-associated mortality rate of 76 deaths per 100,000 live births. Conclusions: We identified high overall rates of adverse pregnancy events and pregnancy-associated death among Veterans using VA benefits. As in non-VA populations, there were stark racial disparities in adverse pregnancy events among Veterans.