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Veterans have significant pre-pregnancy chronic conditions. Identifying five distinct disease patterns can help tailor interventions to reduce pregnancy risks.

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Area of Science:

  • Reproductive Health
  • Chronic Disease Epidemiology
  • Veteran Health

Background:

  • Veterans using Department of Veterans Affairs (VA) healthcare face a high burden of pre-pregnancy chronic diseases.
  • These conditions contribute to elevated rates of pregnancy-related morbidity.
  • Understanding multimorbidity patterns is key for designing effective pre-pregnancy interventions.

Purpose of the Study:

  • To identify patterns of co-occurring pre-pregnancy chronic diseases among Veterans.
  • To inform targeted interventions for improving maternal and infant health outcomes.
  • To analyze the prevalence and clustering of chronic conditions prior to pregnancy in a Veteran population.

Main Methods:

  • Retrospective cohort study utilizing VA administrative data.
  • Inclusion of Veterans aged 18-45 with at least one pregnancy outcome (2010-2019).
  • Latent class models used to group patients based on International Classification of Diseases (ICD-9/10) codes for chronic diseases in the two years preceding pregnancy.

Main Results:

  • Analysis of 56,853 pregnancies from 41,034 Veterans.
  • Over half of pregnancies were complicated by pre-pregnancy medical and mental health conditions.
  • Five distinct groups identified: 'Pain and Mental Health' (28%), 'Pain and Metabolic' (17%), 'Substance Use and Mental Health' (7%), 'Low Diagnosis' (43%), and 'High Complexity' (5%).
  • Chronic pain, depression, anxiety, and PTSD were among the most frequent conditions.

Conclusions:

  • Five clinically meaningful groups of Veterans with distinct pre-pregnancy disease patterns were identified.
  • Interventions tailored to these specific groups can more effectively address complex pre-pregnancy health risks.
  • This approach offers a more efficient strategy for mitigating adverse pregnancy outcomes in the Veteran population.