title: Deployment and Adverse Pregnancy Outcomes: Primary Findings and Methodological Considerations.
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.
authors.affiliation: US Department of Veterans Affairs (VA), Office of Patient Care Services, Women's Health Services, Washington, DC, USA. jodie.katon@va.gov.|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@va.gov.|Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. jodie.katon@va.gov.
authors.forename: Jodie
authors.initials: J
authors.lastname: Katon
authors.affiliation: VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Cypel
authors.affiliation: VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA.
authors.forename: Mubashra
authors.initials: M
authors.lastname: Raza
authors.affiliation: US Department of Veterans Affairs (VA), Office of Patient Care Services, Women's Health Services, Washington, DC, USA.|New York Harbor VA Healthcare System, New York, NY, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Zephyrin
authors.affiliation: 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.|Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.|Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
authors.forename: Gayle
authors.initials: G
authors.lastname: Reiber
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.|Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.affiliation: VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Barth
authors.affiliation: VA Office of Public Health, Post Deployment Health Strategic Healthcare Group, Washington, DC, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Schneiderman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014857:Warfare
keywords: Deployment; Low birth weight; OEF/OIF; Preterm birth; Women Veterans