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2015 HSR&D/QUERI National Conference Abstract

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3098 — Select adverse pregnancy outcomes among women Veterans deployed in service of Operation Enduring Freedom/Operation Iraqi Freedom

Katon JG, VA Puget Sound Health Care System; Cypel Y, VA Office of Public Health, Post Deployment Health Strategic Healthcare Group; Mubashra R, VA Office of Public Health, Post Deployment Health Strategic Healthcare Group; Zephyrin L, VA Office of Patient Care, Women's Health Services; Yano EM, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System; Reiber GE, VA Puget Sound Health Care System; Barth S, VA Office of Public Health, Post Deployment Health Strategic Healthcare Group; Schneiderman A, VA Office of Public Health, Post Deployment Health Strategic Healthcare Group;

Objectives:
Nearly two thirds of women Veterans deployed to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) are of childbearing age, and it is unknown whether deployment is associated with increased risk of adverse pregnancy outcomes. The objective of this study was to determine if deployment to OEF/OIF is associated with increased risk of select adverse pregnancy outcomes among women Veterans.

Methods:
A cohort study was conducted in 2014 analyzing data from the 2009-2011 National Health Study for a New Generation of US Veterans. All pregnancies resulting in a live birth were included. Pregnancies were categorized as occurring among non-deployers, before deployment, during deployment, or after deployment. Adverse pregnancy outcomes included preterm birth, low birth weight, and macrosomia. The association of deployment with adverse pregnancy outcomes was estimated using separate logistic regression models adjusting for maternal age at outcome, race/ethnicity, and lack of independence of outcomes among women contributing multiple pregnancies.

Results:
There were 2,276 live births, including 191 preterm births, 153 low birth weight infants, and 272 macrosomic infants. Compared with pregnancies occurring before deployment, pregnancies among non-deployers and those occurring after deployment were at greater risk of preterm birth (non-deployers: Odds Ratio (OR) = 2.16, 95% Confidence Interval (CI) 1.25, 3.72; after deployment: OR = 1.90, 95% CI 0.90, 4.02). A similar pattern was observed for low birth weight. Deployment was not associated with risk of macrosomia.

Implications:
Compared with non-deployers, deployers have lower risk of select adverse pregnancy outcomes prior to deployment, but similar risk after deployment.

Impacts:
Continued research efforts are needed to verify our findings and to better understand potential pathways through which deployment may increase risk of preterm birth and low birth weight. Given the increased risk for preterm birth and low birth weight associated with deployment to OEF/OIF, providers both inside and outside VA who deliver care to pregnant women need to be aware of their patients' Veteran status and history of deployment OEF/OIF.