Associations Between Childbirth and Women Veterans' VA and Non-VA Hospitalizations for Major Diagnostic Categories

Research Service, VAMC (10A5A), 215 N. Main Street, White River Junction, VT 05009.
Military medicine 11/2013; 178(11):1250-5. DOI: 10.7205/MILMED-D-13-00200
Source: PubMed


Women Veterans enrolled in Veterans Affairs (VA) health care almost always use non-VA hospitals for childbirth, making it more likely they will use non-VA hospitals for other needs, as well. We compared VA and non-VA hospitalizations obtained by VA enrollees in seven states from 2004 through 2007 to determine whether women aged 18 to 44 were more likely to use VA or non-VA care for diagnoses in certain major categories, and how this use differed between women who did or did not have any pregnancy/childbirth admissions during the 4 years. We found that women were hospitalized much more in non-VA than in VA hospitals, though they were relatively more likely to use VA hospitals for mental illness, digestive system diseases, and neoplasms than other diagnoses. Women who gave birth during the time interval had very few VA admissions for any diagnosis, and compared to other women they were also less likely to be hospitalized for mental health or cancer, but more likely to be hospitalized for infectious and parasitic diseases. VA hospitals were used more by women who were slightly older, sicker, poorer, and living nearer to them. VA-using women tend to have different and greater medical needs than those having children.

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    ABSTRACT: Background: A growing number of reproductive-age women veterans are returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). In 2010, 42% of women veterans receiving Veterans Health Administration (VHA) services were aged 18 to 45. Prescription opioid use has increased among all veterans over the past decade; however, exposure among pregnant veterans has not been examined. Methods: We identified 2,331 women who delivered babies within the VHA system between 2001 and 2010. Delivery, opioid prescribing history, and demographic and health-related variables were obtained from a national database of veterans receiving VHA services. Receipt of an opioid prescription was defined as any filled VHA prescription for opioids in the 280-day pregnancy window before delivery. We developed a multivariable logistic regression model adjusted for sociodemographic, service-related, psychiatric diagnosis, and physical health variables to examine the odds of filling an opioid prescription during the pregnancy window. Findings: Ten percent of pregnant veterans received VHA prescription opioids during their pregnancy window. Significant factors associated with opioid prescriptions included presence of any psychiatric diagnosis (adjusted odds ratio [aOR], 1.67; 95% CI, 1.24-2.26), diagnosis of back problems (aOR, 2.94; 95% CI, 1.92-4.49), or other nontraumatic joint disorders (aOR, 2.20; 95% CI, 1.36-3.58). Conclusions: This study suggests that a substantial proportion of women veterans received VHA prescriptions for opioids during pregnancy. Providers should be aware of the potential risks of prescription opioid use during pregnancy, assess for potential undertreatment of psychiatric diagnoses, and consider alternate pain management strategies when possible.
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