title: Predictors of Pregnancy in Female Veterans Receiving a Hormonal Contraceptive Pill, Patch, or Ring.
abstract: BACKGROUND
  Pregnancy rates in veterans are an understudied phenomenon.
  
  
  OBJECTIVE
  The objective of this study was to identify predictors of pregnancy within 1 year of starting hormonal contraception among female veterans.
  
  
  METHODS
  This was a retrospective, cohort study of female veterans from Veterans Affairs facilities within Southern California and Nevada, who newly started hormonal contraception (pill, patch, or ring only) between October 2008 and September 2012. Pregnancy was defined as any event corresponding to a pregnant state using ICD-9 codes. Patients were followed for 1 year post-initiation. Multivariate logistic regression analysis was performed.
  
  
  RESULTS
  The final analysis included a total of 2166 patients. Approximately 5.9% (n = 127) of patients became pregnant during follow-up. Increased odds of pregnancy were associated with the following: mental health disease (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.15-2.58), lowest socioeconomic quintile (OR 1.50, 95% CI 1.05-2.09), and Christian faith (OR 1.69, 95% CI 1.31-2.41). Age groups 25 to 34 years (OR 0.55, 95% CI 0.38-0.92] and 35 to 44 years (OR 0.32, 95% CI 0.06-0.64) were both associated with decreased odds of pregnancy versus age group 18 to 24 years.
  
  
  CONCLUSIONS
  This study successfully identified several predictors of pregnancy in female veterans starting a pill, patch, or ring form of hormonal contraception. Female veterans in the lowest socioeconomic quintile, aged 18 to 24 years, diagnosed with a mental health disorder, and of Christian faith were found to be at significantly higher odds of a pregnancy. Identification of these at-risk populations may help clinicians and policy makers choose strategies to identify which patients could benefit the most from more effective long-acting reversible contraception therapy.
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA rashid.kazerooni@va.gov.
authors.forename: Rashid
authors.initials: R
authors.lastname: Kazerooni
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Blake
authors.affiliation: Veterans Affairs San Diego Healthcare System, San Diego, CA, USA UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, CA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Thai
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003267:Contraception; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D001523:Mental Disorders; D016017:Odds Ratio; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D014728:Veterans; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D003276:Contraceptives, Oral
keywords: clinical research; contraception; obstetrics/gynecology; oral contraceptive; outcomes research/analysis; pharmacometrics; pregnancy/drug effects; prescribing patterns; preventative medicine; women’s health