Deployment and Preterm Birth Among US Army Soldiers

Abstract

With increasing integration of women into combat roles in the US military, it is critical to determine whether deployment, which entails unique stressors and exposures, is associated with adverse reproductive outcomes. Few studies have examined whether deployment increases the risk of preterm birth; no studies (to our knowledge) have examined a recent cohort of servicewomen. We therefore used linked medical and administrative data from the Stanford Military Data Repository for all US Army soldiers with deliveries between 2011 and 2014 to estimate the associations of prior deployment, recency of deployment, and posttraumatic stress disorder with spontaneous preterm birth (SPB), adjusting for sociodemographic, military-service, and health-related factors. Of 12,877 deliveries, 6.1% were SPBs. The prevalence was doubled (11.7%) among soldiers who delivered within 6 months of their return from deployment. Multivariable discrete-time logistic regression models indicated that delivering within 6 months of return from deployment was strongly associated with SPB (adjusted odds ratio = 2.1, 95% confidence interval: 1.5, 2.9). Neither multiple past deployments nor posttraumatic stress disorder was significantly associated with SPB. Within this cohort, timing of pregnancy in relation to deployment was identified as a novel risk factor for SPB. Increased focus on servicewomen's pregnancy timing and predeployment access to reproductive counseling and effective contraception is warranted.

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

“…This study used a cohort of all pregnancies to military women from 2011 to 2014. 11 The overall preterm birth rate of this population was 6.1%, which is well below the national average of 9.6%. 11 However, pregnancies delivered within 6 months of returning from a deployment had a preterm birth rate of 11.7%.…”

“…►Table 1 compares military women's pregnancy outcomes using military-wide databases to the general U.S. population. Preterm birth rates were noted to be lower in the military 11,12 ; gestational diabetes was approximately the same as in the general population, 12,13 but preeclampsia was increased in the military population. 13,14 As the result of their service-related exposures, women who serve in areas of conflict may be exposed to reproductive hazards.…”

“…11 However, pregnancies delivered within 6 months of returning from a deployment had a preterm birth rate of 11.7%. 11 Adjusting for covariants found that those women delivering within 6 months of returning from a deployment had an adjusted odds ratio of preterm birth of 2.1. 11 Women who had a total of three or more deployments and with less than 6 months from return from deployment to delivery had an adjusted odds ratio of 3.8.…”

“…11 Women who had a total of three or more deployments and with less than 6 months from return from deployment to delivery had an adjusted odds ratio of 3.8. 11 This suggests that conception either during or just after return from a deployment almost doubles the preterm birth rate. 11…”

The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans’ Perinatal Outcomes Following Separation From Military Service

“…Specifically, we ran models with the addition of primary military occupational status given that this characteristic was found to differ among women with postpartum depression and/or anxiety in our sample. We also ran models that included the number of deployments, as this has been found to predict preterm birth among active duty female soldiers (Shaw et al., 2018). Finally, we ran models that included health insurance status, as this may impact access to prenatal and mental health care.…”