title: Gestational diabetes and hypertensive disorders of pregnancy among women veterans deployed in service of operations in Afghanistan and Iraq.
abstract: OBJECTIVE
  To determine the prevalence of gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) among women Veterans using Department of Veterans Affairs (VA) maternity benefits previously deployed in service of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND), and whether pregnancy complications were associated with VA use following delivery.
  
  
  METHODS
  We identified the study population through linkage with the Department of Defense roster and VA administrative and clinical data. GDM and HDP were identified by International Classification of Diseases, Ninth Revision codes in VA inpatient or outpatient files. Similarly, we constructed a nationally representative sample of deliveries from the Nationwide Inpatient Sample. We calculated standardized incidence ratios (SIR) adjusted for age and year of delivery to compare rates of GDM and HDP. Proportional hazards regression was used to determine whether pregnancy complications were associated with use of VA following delivery.
  
  
  RESULTS
  Between 2001 and 2010, 2,288 women OEF/OIF/OND Veterans used VA maternity benefits; 5.2% had GDM and 9.6% had HDP. Compared with women delivering in the United States, women OEF/OIF/OND Veterans using VA maternity benefits had higher risk of developing GDM (SIR: 1.40; 95% confidence interval [CI] 1.16, 1.68) and HDP (SIR: 1.32; 95% CI 1.15, 1.51). Among women OEF/OIF/OND Veterans using VA maternity benefits, GDM (HR 1.01, 95% CI 0.83, 1.24) and HDP (HR 1.07, 95% CI 0.92, 1.25) were not associated with use of VA following delivery.
  
  
  CONCLUSIONS
  Non-VA providers should be aware of their patients' Veteran status and the associated elevated risk for pregnancy complications. Within VA, focused efforts to optimize Veterans' preconception and postpartum health are needed.
authors.affiliation: 1 Health Services Research and Development (HSR&D) , Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.
authors.forename: Jodie
authors.initials: J
authors.lastname: Katon
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: Laurie
authors.initials: L
authors.lastname: Zephyrin
authors.forename: Gayle
authors.initials: G
authors.lastname: Reiber
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Lisa
authors.initials: L
authors.lastname: Callegari
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.forename: Joseph
authors.initials: J
authors.lastname: Goulet
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shaw
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007493:Iraq; D054542:Iraq War, 2003-2011; D053208:Kaplan-Meier Estimate; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D015995:Prevalence; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
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