Examining Pre-Pregnancy Health and Maternal Outcomes among Women Veterans

背景资料。在美国，每天有两名妇女死于与怀孕有关的并发症。非- 西班牙裔黑人女性的死亡率是非西班牙裔白人女性的3到4倍，而农村女性的死亡率是非西班牙裔白人女性的3到4倍 低收入地区和妇女也面临更高的风险。每一例与怀孕有关的死亡中，约有100例 更多的妇女几乎死于严重的孕产妇发病率(SMM)，或妊娠和/或并发症 导致重大持久健康后果的分娩。研究表明，这些死亡中的60% SMM事件是可以预防的，而且改善怀孕前妇女的健康(例如，管理 慢性医疗和精神健康疾病)可能是预防的关键之一。人们对女性知之甚少 退伍军人孕前健康风险和产妇结局。试点工作的初步数据表明， 使用退伍军人保健福利的退伍军人中与怀孕相关的死亡率几乎是 全国房价。因为女性退伍军人有很高的慢性医疗和心理健康患病率 条件，并考虑到一半(48%)的18-45岁女性退伍军人认为是非白人，25%生活在农村 在这些领域，至关重要的是审查这些孕前健康风险在不良孕产妇结局中的作用，并 探索健康风险因素在弱势群体中的共病模式有何不同。 重要性/影响力。这项拟议中的研究将填补有关该病病因的文献中的主要空白。 退伍军人事务部内外的孕产妇死亡率和SMM，并与VHA和HSR&D优先事项直接一致 围绕妇女健康和健康公平。创新。这项研究是第一次检查Pre-Rate的影响 全国退伍军人和第一批女性退伍军人的妊娠健康风险对孕产妇结局的影响 研究社会特征是否会改变孕前健康和产妇之间的关系 结果。明确的目标。目标1是一项根据共生情况对女性退伍军人进行分类的定量研究 孕前健康风险，描述风险概况组与不良孕产妇结局之间的关系， 并确定这些关联如何在不同的人口亚群中变化。目标2是要检查的定性研究 女性退伍军人孕前保健需求、经验和偏好。目标3涉及干预 利用主要退伍军人管理局临床和运营信息员的投入进行开发、改进和试行测试 女退伍军人。方法论。目标1将使用潜在分类分析和多元回归来检验 2010-2019财年，全国共有30,000多名退伍军人怀孕。目标2将招募和 采访约30名女退伍军人，了解她们在孕前健康和健康方面的经验和需求 在退伍军人事务部的护理。AIM 3将招募~6名退伍军人临床和手术信息员和~3名退伍军人 利益相关者咨询小组，5-10名女性退伍军人及其提供者提供干预反馈 10-15名女性退伍军人和提供者对干预组件进行试点测试。 实施/后续步骤。调查结果将提交给当地和国家运营合作伙伴，并将 直接通知后续研究，以测试一套以患者为中心的孕前健康状况 多个退伍军人初级保健地点的干预策略。候选人。Deirdre Quinn博士是一名博士后 退伍军人事务部健康公平研究和促进中心妇女健康研究员。目的 CDA-2是为了帮助Quinn博士成功过渡到独立的退伍军人健康服务调查员 重点是实现女性退伍军人生殖健康的质量和公平。CDA-2的目标是 研究旨在检查女性退伍军人孕前健康风险(例如慢性疾病)之间的联系 条件)、社会特征(例如，种族/民族、乡村)、保健经历和母亲 结果可以为改善女性退伍军人的医疗保健提供机会。这一目标将会实现 通过专家指导和深入培训：(1)高级定量研究；(2)定性研究； (3)设计和测试改善妇女健康的干预策略；(4)专业领导力。

Background. In the United States, two women die every day from pregnancy-related complications. Non- Hispanic Black women die at 3 to 4 times the rate of non-Hispanic White women, and women living in rural areas and women with low income are also at increased risk. For every pregnancy-related death, about 100 more women nearly die due to severe maternal morbidity (SMM), or complications from pregnancy and/or delivery that result in significant lasting health consequences. Research suggests that >60% of these deaths and SMM events are preventable, and that improving women’s health before pregnancy (e.g., managing chronic medical and mental health conditions) may be one key to prevention. Little is known about women Veterans’ pre-pregnancy health risks and maternal outcomes. Preliminary data from pilot work suggest that the rate of pregnancy-associated deaths among Veterans using VA maternity care benefits is nearly double the national rate. Because women Veterans have a high prevalence of chronic medical and mental health conditions, and given that half (48%) of women Veterans age 18-45 identify as non-White and 25% live in rural areas, it is critical to examine the role of these pre-pregnancy health risks in adverse maternal outcomes and to explore how patterns of comorbid health risk factors vary among women from vulnerable subgroups. Significance / Impact. The proposed research will fill major gaps in the literature about the etiology of maternal mortality and SMM both within and outside of VA, and directly aligns with VHA and HSR&D priorities around women’s health and health equity. Innovation. This study is the first to examine the impact of pre- pregnancy health risks on maternal outcomes among a national cohort of women Veterans and the first to examine whether social characteristics modify associations between pre-pregnancy health and maternal outcomes. Specific Aims. Aim 1 is a quantitative study to classify women Veterans according to co-occurring pre-pregnancy health risks, describe associations between risk profile groups and adverse maternal outcomes, and identify how these associations vary across population subgroups. Aim 2 is a qualitative study to examine women Veterans’ pre-pregnancy healthcare needs, experiences, and preferences. Aim 3 involves intervention development, refinement, and pilot testing with the input of key VA clinical and operational informants and women Veterans. Methodology. Aim 1 will use latent class analysis and multiple regression to examine a national cohort of over 30,000 pregnancies to women Veterans in FY2010-2019. Aim 2 will recruit and interview ~30 women Veterans about their experiences and needs related to pre-pregnancy health and health care in VA. Aim 3 will recruit ~6 VA clinical and operational informants and ~3 women Veterans for a VA stakeholder advisory panel, 5-10 women Veterans and their providers to provide feedback on intervention components, and 10-15 women Veterans and providers to pilot test the intervention components. Implementation / Next Steps. Findings will be presented to local and national operations partners and will directly inform follow-up research to test one or more of a set of patient-centered pre-pregnancy health intervention strategies in multiple VA primary care sites. Candidate. Dr. Deirdre Quinn is a postdoctoral research fellow in women’s health at the VA Center for Health Equity Research and Promotion. The purpose of this CDA-2 is to facilitate Dr. Quinn’s successful transition to an independent VA health services investigator focused on achieving quality and equity in women Veterans’ reproductive health. The objective of this CDA-2 research is to examine how links between women Veterans’ pre-pregnancy health risks (e.g., chronic conditions), social characteristics (e.g., race/ethnicity, rurality), healthcare experiences, and maternal outcomes can inform opportunities to improve women Veterans’ healthcare. This objective will be achieved through expert mentorship and in-depth training in: (1) advanced quantitative research; (2) qualitative research; (3) designing and testing intervention strategies to improve women’s health; and (4) professional leadership.