Semin Reprod Med 2019; 37(01): 017-023
DOI: 10.1055/s-0039-1692128
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

Michele Hugin
1  Division of Gynecology, Department of Surgery, VA Palo Alto Health Care System, Palo Alto, California
2  Division of Family Planning, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Jonathan G. Shaw
3  Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
4  Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California
› Author Affiliations
Further Information

Publication History

Publication Date:
11 June 2019 (online)

Abstract

In the post-9/11 era, the number of young women serving, and deploying, in the military grew rapidly; as they exit service, there is tremendous increase in reproductive-aged women Veterans. Here, we review the limited but growing research regarding Veterans' pregnancy and obstetric outcomes. U.S. women Veterans returning from deployment carry a high burden of physical and mental health conditions, and often trauma. As poor mental health is known to predict poorer maternal and infant sequelae, there are unique concerns around perinatal outcomes in Veterans. Accordingly, there is new attention to their reproductive risks and needs—evidenced by recent research and programmatic efforts within the VA. Emerging research suggests that the unique health profiles of pregnant Veterans, including prevalent posttraumatic stress disorder, predict increased risk of preterm birth, preeclampsia, and gestational diabetes. In the most contemporary large study, relying on California birth data, Veterans who relied on VA for their health care coverage were high risk, with increased rates of preeclampsia and Cesarean delivery. Additionally, Veterans' infants (compared with non-Veterans') were more likely to require NICU care. Additional research is needed to explore upstream factors leading to these poorer outcomes. Current effort to coordinate VA and non-VA care for Veteran mothers is warranted.