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Am J Perinatol 2024; 41(02): 150-159
DOI: 10.1055/s-0041-1740248
Original Article

Severe Maternal Morbidity among Women in the U. S. Military, 2003–2015

Clinton Hall
1   Deployment Health Research Department, Naval Health Research Center, San Diego, California
2   Leidos Inc., San Diego, California
,
Celeste J. Romano
1   Deployment Health Research Department, Naval Health Research Center, San Diego, California
2   Leidos Inc., San Diego, California
,
Anna T. Bukowinski
1   Deployment Health Research Department, Naval Health Research Center, San Diego, California
2   Leidos Inc., San Diego, California
,
Gia R. Gumbs
1   Deployment Health Research Department, Naval Health Research Center, San Diego, California
2   Leidos Inc., San Diego, California
,
Kaitlyn N. Dempsey
3   School of Medicine, Uniformed Services University, Bethesda, Maryland
4   Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia
,
Aaron T. Poole
4   Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia
5   Las Palmas Del Sol Healthcare, El Paso, Texas
,
Ava Marie S. Conlin
1   Deployment Health Research Department, Naval Health Research Center, San Diego, California
,
Shannon V. Lamb
6   Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
› Author Affiliations Funding This work was supported by the U.S. Navy Bureau of Medicine and Surgery under work unit no. 60504.
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Abstract

Objective This study aimed to assess trends and correlates of severe maternal morbidity at delivery among active duty women in the U.S. military, all of whom are guaranteed health care and full employment.

Study Design Linked military personnel and medical encounter data from the Department of Defense Birth and Infant Health Research program were used to identify a cohort of delivery hospitalizations among active duty military women from January 2003 through August 2015. Cases of severe maternal morbidity were identified by applying 21- and 20-condition algorithms (with and without blood transfusion) developed by the Centers for Disease Control and Prevention. Rates (per 10,000 delivery hospitalizations) were reported overall and by specific condition. Multivariable Poisson regression models estimated associations with demographic, clinical, and military characteristics.

Results Overall, 187,063 hospitalizations for live births were included for analyses. The overall 21- and 20-condition severe maternal morbidity rates were 111.7 (n = 2089) and 37.4 (n = 699) per 10,000 delivery hospitalizations, respectively. The 21-condition rate increased by 184% from 2003 to 2015; the 20-condition rate increased by 40%. Compared with non-Hispanic White women, the adjusted 21-condition rate of severe maternal morbidity was higher for Hispanic (adjusted rate ratio [aRR] = 1.28, 95% confidence interval [CI]: 1.13–1.46), non-Hispanic Black (aRR = 1.34, 95% CI: 1.21–1.49), Asian/Pacific Islander (aRR = 1.35, 95% CI: 1.13–1.61), and American Indian/Alaska Native (aRR = 1.39, 95% CI: 1.06–1.82) women. Rates also varied by age, clinical factors, and deployment history.

Conclusion Active duty U.S. military women experienced an increase in severe maternal morbidity from 2003 to 2015 that followed national trends, despite protective factors such as stable employment and universal health care. Similar to other populations, military women of color were at higher risk for severe maternal morbidity relative to non-Hispanic White military women. Continued surveillance and further investigation into maternal health outcomes are critical for identifying areas of improvement in the Military Health System.

Key Points

  • Cesarean delivery and multiple birth were the strongest correlates of severe maternal morbidity in this population.

  • Racial disparities persisted across indicators of severe maternal morbidity.

  • Rates of disseminated intravascular coagulation were higher than those reported nationally.

Keywords

severe maternal morbidity - pregnancy complications - racial disparities - military

Note

I am a military service member or employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, USC. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, USC. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official duties.


Report no. 20–90 was supported by the U.S. Navy Bureau of Medicine and Surgery under work unit no. 60504. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.


The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center, Institutional Review Board protocol, number: NHRC.1999.0003.


Supplementary Material



Publication History

Received: 05 March 2021

Accepted: 04 October 2021

Article published online:
10 December 2021

© 2021. Thieme. All rights reserved.

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