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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1067 — Severe maternal morbidity and pregnancy-associated death among Veterans

Lead/Presenter: Deirdre Quinn,  COIN - Pittsburgh/Philadelphia
All Authors: Quinn DA (Center for Health Equity Research & Promotion, VA Pittsburgh), Sileanu, FE (Center for Health Equity Research & Promotion, VA Pittsburgh) Mor, MK (Center for Health Equity Research & Promotion, VA Pittsburgh) Callegari, LS (Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound) Borrero, S (Center for Health Equity Research & Promotion, VA Pittsburgh)

Objectives:
Veterans using Veteran Health Administration (VA) maternity benefits may be at high risk for adverse pregnancy outcomes, including severe maternal morbidity (SMM) and pregnancy-associated death, due to prior health comorbidities and social risks, but little is known about the prevalence of these outcomes in this population. The objective of this study was to examine national VA administrative data to describe severe maternal morbidity and pregnancy-associated death among all Veterans using VA maternity care benefits.

Methods:
We conducted a retrospective cohort study using VA national administrative data for Veterans ages 18-45 with at least one pregnancy outcome (ectopic, spontaneous abortion, stillbirth, and/or live birth) during fiscal years (FY 2010-2017) and a VA primary care visit within one year prior to pregnancy. We identified SMM during pregnancy and up to 42 days after pregnancy using the Center for Disease Control and Prevention’s list of indicators for SMM during delivery hospitalizations. We captured pregnancy-associated death (i.e., death from any cause during pregnancy or within one year of pregnancy outcome) using the VA Vital Status file. We compared prevalence of SMM by the Veteran’s race/ethnicity using age-adjusted logistic regression.

Results:
We identified 31,592 pregnancy outcomes from 23,432 Veterans using VA primary care and maternity benefits during FY10-17. One or more SMM events were recorded for 2.7% of pregnancies. Pregnancies among Black Veterans had higher odds of any SMM than those among white Veterans (OR = 1.65, 95%CI: 1.41,1.91). Maternal death during pregnancy or within one year of pregnancy outcome was recorded for 18 pregnancies, resulting in an estimated pregnancy-associated mortality rate of 76.49 deaths per 100,000 live births.

Implications:
We identified high overall rates of SMM and pregnancy-associated death among Veterans using VA maternity care benefits and stark racial disparities in SMM. Additional research is needed to identify potential gaps in care for patients within VA and to understand the root causes of adverse maternal outcomes among Veterans using VA maternity care benefits.

Impacts:
Establishing baseline rates of SMM and maternal death as well as procedures for rapid surveillance of these outcomes using administrative data is critical as access to safe and legal abortion continues to be restricted across the United States. Recent modeling estimates suggest that decreased access to abortion will increase the number of pregnancy-related deaths and widen racial disparities in adverse maternal outcomes. Given that nearly half of women Veterans of reproductive age currently access care in states that have or are likely to ban abortion, this study and additional research will be critical for understanding and improving maternal health among Veterans.