Veterans Using VA Benefits Experience High Rates of Adverse Pregnancy Events and Pregnancy-Associated Death, with Black Veterans Most at Risk
BACKGROUND:
VA currently provides maternity benefits to approximately 6,000 Veterans per year through community care, but little is known about rates of adverse pregnancy events or pregnancy-associated death among Veterans. In this study, researchers examined VA administrative data for 22,491 Veterans ages 18-45 (mean age 30; 56% White, 27% Black, 11% Hispanic) with at least one pregnancy outcome between October 2009 and September 2016 and a VA primary care visit within one year prior to pregnancy. The study aimed to assess the prevalence of adverse events during pregnancy and up to 42 days after pregnancy, and pregnancy-associated death (death from any cause while pregnant or within 1 year of the end of pregnancy), and to compare prevalence of adverse events by Veteran race/ethnicity.
FINDINGS:
- Nearly 3% of pregnancies recorded an adverse event. Pregnancies among Black Veterans had 69% higher odds of any adverse event compared to those among White Veterans even after adjusting for potential confounders, including geographic location, rurality, and VA enrollment priority group.
- Death during or within 1 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—nearly double the highest reported national non-VA rate.
- Veterans with a service-connected disability (71% of the overall sample) were more likely to have an adverse pregnancy event (73% of the sample with adverse events) than Veterans with no service-connected disability.
IMPLICATIONS:
- The unique risk profile of Veterans who use VA maternity benefits is likely an important driver of observed disparities in adverse pregnancy events and the high rate of pregnancy-associated deaths.
- Research to understand more about cases of pregnancy-associated death that may be attributed to non-pregnancy related causes such as suicide or substance use will be important to identify meaningful targets for intervention at the health system level. Also, exploring Black Veterans’ experiences of pregnancy and postpartum care while using VA maternity benefits is needed to inform multilevel interventions that can reduce racial disparities and improve maternal outcomes.
LIMITATIONS:
- The study’s inclusion of all pregnancies, including miscarriages and ectopic pregnancies, and use of an expanded outcome measure that included adverse events during pregnancy and postpartum, limits comparison to non-VA studies.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR. Drs. Quinn, Sileanu, Mor, and Borrero are with HSR’s Center for Health Equity Research and Promotion (CHERP). Dr. Callegari is with HSR’s Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care. Dr. Quinn is also supported by an HSR Career Development Award.
Quinn DA, Sileanu FE, Mor MK, Callegari LS, Borrero S. Describing Adverse Pregnancy Events and Pregnancy-Associated Death Among Veterans. Journal of Women’s Health. September 20, 2024; online ahead of print.
