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Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations

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Abstract

Objective To characterize the pregnancy outcomes of women Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans including prevalence of preterm delivery, low birth weight, and macrosomia, and to highlight methodological limitations that can impact findings. Methods A retrospective cohort study was conducted starting in 2014 analyzing data from the 2009 to 2011 National Health Study for a New Generation of US Veterans, which sampled Veterans deployed and not deployed to OIF/OEF. All pregnancies resulting in a live birth were included, and categorized as occurring among non-deployers, before deployment, during deployment, or after deployment. Outcomes included preterm birth, low birth weight, and macrosomia. The association of deployment with selected outcomes was estimated using separate general estimating equations to account for lack of outcome independence among women contributing multiple pregnancies. Adjustment variables included maternal age at outcome, and race/ethnicity. Results There were 2276 live births (191 preterm births, 153 low birth weight infants, and 272 macrosomic infants). Compared with pregnancies before deployment, pregnancies among non-deployers and those after deployment appeared to have greater risk of preterm birth [non-deployers: odds ratio (OR) = 2.16, 95 % confidence interval (CI) 1.25, 3.72; after deployment: OR = 1.90, 95 % CI 0.90, 4.02]. A similar pattern was observed for low birth weight. No association of deployment with macrosomia was detected. Discussion Compared with non-deployers, those who eventually deploy appear to have better pregnancy outcomes prior to deployment, but this advantage is no longer apparent after deployment. Non-deployers may not be an appropriate reference group to study the putative health impacts of deployment on pregnancy outcomes.

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Acknowledgments

This study was funded by the US Department of Veterans Affairs (VA), Office of Public Health. Dr. Katon was supported by an Office of Academic Affiliations’ Associated Health Postdoctoral Fellowship (#TTP 61-026), by the VA Office of Patient Care, Women’s Health Services, and by the VA Puget Sound Center of Innovation in Patient-Centered and Value-Driven Care. Drs. Reiber (#RCS-98-353) and Yano (#RCS-05-195) are supported by VA HSR&D Senior Research Career Scientist awards. The views expressed within are solely those of the authors, and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. The authors would like to acknowledge Katherine Hoggatt, PhD and Kristen Gray, PhD for providing a critical review of the manuscript.

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Authors and Affiliations

  1. US Department of Veterans Affairs (VA), Office of Patient Care Services, Women’s Health Services, Washington, DC, USA

    Jodie Katon & Laurie Zephyrin

  2. VA Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, 1660 South Columbia Way S-152, Seattle, WA, 98108, USA

    Jodie Katon & Gayle Reiber

  3. Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA

    Jodie Katon & Gayle Reiber

  4. VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA

    Yasmin Cypel, Mubashra Raza, Shannon Barth & Aaron Schneiderman

  5. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

    Gayle Reiber

  6. New York Harbor VA Healthcare System, New York, NY, USA

    Laurie Zephyrin

  7. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Elizabeth M. Yano

  8. Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano

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  1. Jodie Katon
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  2. Yasmin Cypel
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Katon, J., Cypel, Y., Raza, M. et al. Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations. Matern Child Health J 21, 376–386 (2017). https://doi.org/10.1007/s10995-016-2122-x

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