Download PDF
Semin Reprod Med 2019; 37(05/06): 215-221
DOI: 10.1055/s-0040-1712929
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obstetric Outcomes in Military Servicewomen: Emerging Knowledge, Considerations, and Gaps

Kathryn Mezwa
1   Boston University School of Public Health, Boston, Massachusetts
,
Lee Adelsheim
1   Boston University School of Public Health, Boston, Massachusetts
,
Glenn Markenson
2   Boston University School of Medicine, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
25 June 2020 (online)

    Permissions and Reprints

Abstract

The number of women in the U.S. military is dramatically increasing. Similarly, the roles of active-duty women are greatly expanding, thus exposing them to new occupational risks. Determining the impact of pregnancy outcomes for women while in the military is difficult due to changing exposures over time, difficulty in utilizing appropriate comparison groups, and the lack of prospective investigations. Despite these limitations, it was concerning that the available data suggest that servicewomen delivering within 6 months of their first deployment have an increased preterm birth risk (adjusted odds ratio [aOR]: 2.1), and those with three prior deployments have an even greater risk (aOR: 3.8). Servicewomen also have an increased risk of hypertensive disorders with a rate of 13% compared with 5% in the general obstetric population. Furthermore, depression is higher for women who deploy after childbirth and are exposed to combat when compared with those who have not deployed since the birth of their child (aOR: 2.01). Due to the importance of this issue, prospective research designs are necessary to better understand and address the unique health care needs of this population.

Keywords

reproductive health - obstetrics - birth outcomes - psychiatric outcomes - military medicine
 

  • References

  • 1 Stahlman S, Witkop CT, Clark LL, Taubman SB. Pregnancies and live births, active component service women, U.S. Armed Forces, 2012-2016. MSMR 2017; 24 (11) 2-9
    PubMedSearch in Google Scholar
  • 2 Williams K. It's My Country Too: Women's Military Stories from the American Revolution to Afghanistan. University of Nebraska Press; 2017
    Search in Google Scholar
  • 3 2015 Demographics: Profile of the Military Community. Office of the Deputy Assistant Secretary of Defense; 2016
    Search in Google Scholar
  • 4 Grobman WA, Bailit JL, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol 2015; 125 (06) 1460-1467
    CrossrefPubMedSearch in Google Scholar
  • 5 Tilghman A. All combat jobs open to women in the military. Military Times. Available at: https://www.militarytimes.com/2015/12/03/all-combat-jobs-open-to-women-in-the-military/ . December 12, 2015. Accessed August 14, 2018
    PubMed
  • 6 Krulewitch CJ. Reproductive health of active duty women in medically austere environments. Mil Med 2016; 181 (1, Suppl): 63-69
    CrossrefPubMedSearch in Google Scholar
  • 7 Nguyen S, Leardmann CA, Smith B. , et al; Millennium Cohort Study Team. Is military deployment a risk factor for maternal depression?. J Womens Health (Larchmt) 2013; 22 (01) 9-18
    CrossrefPubMedSearch in Google Scholar
  • 8 Fox ME, Harris RE, Brekken AL. The active-duty military pregnancy: a new high-risk category. Am J Obstet Gynecol 1977; 129 (06) 705-707
    CrossrefPubMedSearch in Google Scholar
  • 9 Hauth JC, Gilstrap III LC, Brekken AL, Hauth JM. The effect of 17 alpha-hydroxyprogesterone caproate on pregnancy outcome in an active-duty military population. Am J Obstet Gynecol 1983; 146 (02) 187-190
    CrossrefPubMedSearch in Google Scholar
  • 10 Magann EF, Nolan TE. Pregnancy outcome in an active-duty population. Obstet Gynecol 1991; 78 (3, Pt 1): 391-393
    PubMedSearch in Google Scholar
  • 11 Shaw JG, Nelson DA, Shaw KA, Woolaway-Bickel K, Phibbs CS, Kurina LM. Deployment and preterm birth among US army soldiers. Am J Epidemiol 2018; 187 (04) 687-695
    CrossrefPubMedSearch in Google Scholar
  • 12 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep 2018; 67 (01) 1-55
    PubMedSearch in Google Scholar
  • 13 Stahlman S, Witkop CT, Clark LL, Taubman SB. Complications and care related to pregnancy, labor, and delivery among active component service women, U.S. Armed Forces, 2012-2016. MSMR 2017; 24 (11) 22-29
    PubMedSearch in Google Scholar
  • 14 Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ 2013; 347: f6564
    CrossrefPubMedSearch in Google Scholar
  • 15 Langlois PH, Ramadhani TA, Royle MH, Robbins JM, Scheuerle AE, Wyszynski DF. Birth defects and military service since 1990. Mil Med 2009; 174 (02) 170-176
    CrossrefPubMedSearch in Google Scholar
  • 16 The Centers for Disease Control Vietnam Experience Study. Health status of Vietnam veterans. III. Reproductive outcomes and child health. JAMA 1988; 259 (18) 2715-2719
    CrossrefPubMedSearch in Google Scholar
  • 17 Kang HK, Mahan CM, Lee KY, Magee CA, Mather SH, Matanoski G. Pregnancy outcomes among U.S. women Vietnam veterans. Am J Ind Med 2000; 38 (04) 447-454
    CrossrefPubMedSearch in Google Scholar
  • 18 Duerk B. Women in U.S. military during Desert Shield/Desert Storm [Internet]. Naval History and Heritage Command. U. S. Navy; 2017 [cited August 14, 2018]. Available at: https://www.history.navy.mil/browse-by-topic/diversity/women-in-the-navy/during-desert-shield-desert-storm.html . Accessed May 10, 2020
    PubMedSearch in Google Scholar
  • 19 Wells TS, Wang LZ, Spooner CN. , et al. Self-reported reproductive outcomes among male and female 1991 Gulf War era US military veterans. Matern Child Health J 2006; 10 (06) 501-510
    CrossrefPubMedSearch in Google Scholar
  • 20 Doyle P, Maconochie N, Ryan M. Reproductive health of Gulf War veterans. Philos Trans R Soc Lond B Biol Sci 2006; 361 (1468): 571-584
    CrossrefPubMedSearch in Google Scholar
  • 21 Wheeler W, Kroemer K, Coperland R. , et al. Operation Desert Storm. Questions Remain on Possible Exposure to Reproductive Toxicants. Washington, DC: Government Accountability Office; 1994
    Search in Google Scholar
  • 22 Araneta MR, Destiche DA, Schlangen KM, Merz RD, Forrester MB, Gray GC. Birth defects prevalence among infants of Persian Gulf War veterans born in Hawaii, 1989-1993. Teratology 2000; 62 (04) 195-204
    CrossrefPubMedSearch in Google Scholar
  • 23 Araneta MR, Schlangen KM, Edmonds LD. , et al. Prevalence of birth defects among infants of Gulf War veterans in Arkansas, Arizona, California, Georgia, Hawaii, and Iowa, 1989-1993. Birth Defects Res A Clin Mol Teratol 2003; 67 (04) 246-260
    CrossrefPubMedSearch in Google Scholar
  • 24 Kang H, Magee C, Mahan C. , et al. Pregnancy outcomes among U.S. Gulf War veterans: a population-based survey of 30,000 veterans. Ann Epidemiol 2001; 11 (07) 504-511
    CrossrefPubMedSearch in Google Scholar
  • 25 Veterans and Spina Bifida. U.S. Department of Veterans Affairs, Public Health. Available at: https://www.publichealth.va.gov/exposures/agentorange/birth-defects/spina-bifida.asp 2016 . Accessed August 13, 2018
    PubMed
  • 26 Ngo AD, Taylor R, Roberts CL, Nguyen TV. Association between Agent Orange and birth defects: systematic review and meta-analysis. Int J Epidemiol 2006; 35 (05) 1220-1230
    CrossrefPubMedSearch in Google Scholar
  • 27 Bukowinski AT, DeScisciolo C, Conlin AMS, , K Ryan MA, Sevick CJ, Smith TC. Birth defects in infants born in 1998-2004 to men and women serving in the U.S. military during the 1990-1991 Gulf War era. Birth Defects Res A Clin Mol Teratol 2012; 94 (09) 721-728
    CrossrefPubMedSearch in Google Scholar
  • 28 Wiesen AR, Littell CT. Relationship between prepregnancy anthrax vaccination and pregnancy and birth outcomes among US Army women. JAMA 2002; 287 (12) 1556-1560
    CrossrefPubMedSearch in Google Scholar
  • 29 Ryan MA, Gumbs GR, Conlin AM. , et al; Department of Defense Birth and Infant Health Registry Team. Evaluation of preterm births and birth defects in liveborn infants of US military women who received smallpox vaccine. Birth Defects Res A Clin Mol Teratol 2008; 82 (07) 533-539
    CrossrefPubMedSearch in Google Scholar
  • 30 Ryan MA, Smith TC, Sevick CJ. , et al. Birth defects among infants born to women who received anthrax vaccine in pregnancy. Am J Epidemiol 2008; 168 (04) 434-442
    CrossrefPubMedSearch in Google Scholar
  • 31 Conlin AM, Bukowinski AT, Sevick CJ, DeScisciolo C, Crum-Cianflone NF. Safety of the pandemic H1N1 influenza vaccine among pregnant U.S. military women and their newborns. Obstet Gynecol 2013; 121 (03) 511-518
    CrossrefPubMedSearch in Google Scholar
  • 32 Ryan MA, Pershyn-Kisor MA, Honner WK, Smith TC, Reed RJ, Gray GC. The Department of Defense Birth Defects Registry: overview of a new surveillance system. Teratology 2001; 64 (Suppl. 01) S26-S29
    CrossrefPubMedSearch in Google Scholar
  • 33 Bukowinski AT, Conlin AMS, Gumbs GR, Khodr ZG, Chang RN, Faix DJ. Department of Defense Birth and Infant Health Registry: select reproductive health outcomes, 2003-2014. MSMR 2017; 24 (11) 39-49
    PubMedSearch in Google Scholar
  • 34 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; 2013: 947
    Search in Google Scholar
  • 35 Klaman SL, Turner K. Prevalence of perinatal depression in the military: a systematic review of the literature. Matern Child Health J 2016; 20 (Suppl. 01) 52-65
    CrossrefPubMedSearch in Google Scholar
  • 36 Levine JA, Bukowinski AT, Sevick CJ, Mehlhaff KM, Conlin AMS. Postpartum depression and timing of spousal military deployment relative to pregnancy and delivery. Arch Gynecol Obstet 2015; 292 (03) 549-558
    CrossrefPubMedSearch in Google Scholar
  • 37 Smith DC, Munroe ML, Foglia LM, Nielsen PE, Deering SH. Effects of deployment on depression screening scores in pregnancy at an army military treatment facility. Obstet Gynecol 2010; 116 (03) 679-684
    CrossrefPubMedSearch in Google Scholar
  • 38 Mattocks KM, Skanderson M, Goulet JL. , et al. Pregnancy and mental health among women veterans returning from Iraq and Afghanistan. J Womens Health (Larchmt) 2010; 19 (12) 2159-2166
    CrossrefPubMedSearch in Google Scholar
  • 39 Patten E, Parker K. A Snapshot of Active Duty Women. Pew Research Center's Social & Demographic Trends project. 2011 . Available at: http://www.pewsocialtrends.org/2011/12/22/a-snapshot-of-active-duty-women/ . Accessed July 25, 2018
    PubMedSearch in Google Scholar
  • 40 Robrecht DT, Millegan J, Leventis LL, Crescitelli J-B, McLay RN. Spousal military deployment as a risk factor for postpartum depression. J Reprod Med 2008; 53 (11) 860-864
    PubMedSearch in Google Scholar
  • 41 Araneta MRG, Kamens DR, Zau AC. , et al. Conception and pregnancy during the Persian Gulf War: the risk to women veterans. Ann Epidemiol 2004; 14 (02) 109-116
    CrossrefPubMedSearch in Google Scholar
  • 42 Lehavot K, Hoerster KD, Nelson KM, Jakupcak M, Simpson TL. Health indicators for military, veteran, and civilian women. Am J Prev Med 2012; 42 (05) 473-480
    CrossrefPubMedSearch in Google Scholar
  • 43 Melin J. Desperate choices: Why black women join the U.S. military at higher rates than men and all other racial and ethnic groups. N Engl J Public Policy 2016; 28 (02) 8
    PubMedSearch in Google Scholar
  • 44 Barfield WD, Wise PH, Rust FP, Rust KJ, Gould JB, Gortmaker SL. Racial disparities in outcomes of military and civilian births in California. Arch Pediatr Adolesc Med 1996; 150 (10) 1062-1067
    CrossrefPubMedSearch in Google Scholar
  • 45 Engelhardt KA, Hisle-Gorman E, Gorman GH, Dobson NR. Lower preterm birth rates but persistent racial disparities in an open-access health care system. Mil Med 2018; 183 (9-10): e570-e575
    CrossrefPubMedSearch in Google Scholar