3048 — Obstetric Outcomes in the VA - Comparison with a Nationally Representative Sample to Guide Future VA Research and Quality Measures

Shaw JG, VA Palo Alto & Stanford University; Katon J, VA Puget Sound & University of Washington; Asch SM, VA Palo Alto & Stanford University; Mattocks KM, VA Central Western Massachusetts & University of Massachusetts; Zephyrin LC, VA Women's Health Services & New York University; Phibbs CS, VA Palo Alto & Stanford University;

Objectives:
The Veterans Health Administration (VA) increasingly provides maternity care coverage for women Veterans, yet little is known about their obstetric outcomes. Prior research demonstrates that, compared with the general population, women Veterans in VA have higher rates of chronic medical and mental health conditions. Whether this increased burden of illness translates to poorer obstetric outcomes is uncertain. This study aims to quantify the obstetric risk profile of Veterans receiving VA maternity benefits, evaluating whether pregnancy complications exceed the expected population-based incidence.

Methods:
We compared all VA-reimbursed inpatient delivery claims for 2003-2010 (n = 10,392) from national VA administrative data to delivery claims for the same period (n = 30 million) from the National Inpatient Sample (NIS), a representative sample of United States inpatient hospital discharges. We used diagnosis-related groups (DRGs) to identify deliveries, and diagnostic codes (ICD-9) to identify clinically relevant outcomes including: gestational diabetes (GDM), preeclampsia, pregnancy-induced hypertension, spontaneous preterm birth, cesarean delivery, and placental abruption. Using indirect standardization (standardized incidence ratio [SIR], 95% confidence interval) we compared obstetric outcomes in the VA and NIS (reference) cohorts, adjusting for age and year of delivery.

Results:
Unadjusted incidences of all complications"”including preeclampsia (4.3%), gestational diabetes (5.6%), spontaneous preterm delivery (7.8%) and cesarean delivery (34.2%)"”were higher in Veterans receiving VA maternity care than in the NIS reference sample. The VA sample had a lower proportion of young mothers (age 19-24) than the NIS (18% vs 31%). After adjustment for age and year of delivery, only preeclampsia remained significantly higher (SIR 1.11, 1.01-1.21).

Implications:
Pregnancies among women utilizing VA maternity benefits are at elevated risk of preeclampsia. Veterans receiving maternity care represent an older, higher-risk population"”relative to national sample"”but the increased absolute incidences of other common obstetric complications do not persist after standardizing for age and delivery year.

Impacts:
Establishing the obstetric risk profile of Veterans in the VA healthcare system is an important step in developing research and programmatic efforts to ensure women Veterans receive high quality maternity and newborn care. Potential contributors to increased risk of preeclampsia, and close monitoring of patterns of cesarean and preterm delivery deserve close attention in this population.