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BACKGROUND/RATIONALE:
The reproductive process is very sensitive to environmental exposures and environmental exposures can affect reproductive outcomes with very long time lags. There are many ways in which military service might contribute to exposures that could have adversely effect the reproductive process, including exposure to hazardous substances, the stress of combat, and military sexual trauma. The proportion and number of women veterans has been steadily increasing, as well as demographic shifts to a higher proportion of younger and minority women. Women are predicted to account for over 10% of all veterans by 2010, given the percentage of women currently serving in the military (15% of the active duty military and 23% of the reserve military forces). Younger women veterans are more likely to be from minority groups, with African-Americans accounting for 26% of women veterans less than 45 years old. The large share of African-Americans is of specific concern, given their much higher rates of extreme prematurity in the general population. Further, while studies of reproductive outcomes tend to focus on the mothers and infants, environmental exposures of the father can also have adverse effects; sperm mutate much more easily than eggs. There is limited knowledge regarding how the reproductive outcomes of veterans compare with non-veterans, and how birth outcomes compare for veterans who have served in specific theaters of operation (e.g. OEF/OIF) with the birth outcomes for veterans who have not served in these locales.
OBJECTIVE(S):
This proposed short-term project will examine the feasiblity of conducting a study of reproductive outcomes for veterans. This pilot/feasiblity study has two objectives. 1) Confirm that we can actually link veterans to one year (2006) of the California linked perinatal data. 2) Conduct some initial analyses using the 2006 data to determine the sample sizes of deliveries to male and female veterans and conduct some initial exploratory analyses which will serve as pilot data for a larger IIR proposal.
The purpose of the full IIR proposal would be to link veterans to multiple years of the California perinatal data, stretching back to 1991, and use these data to study veterans' pregnancy outcomes; both compared to non-veterans, and within subgroups of veterans such as service in the 1st Gulf War or OEF/OIF, those with serious mental health conditions such as PTSD, and those exposed to military sexual trauma.
METHODS:
We will cross-link Veterans Health Administration, Veterans Benefits Administration, and California birth cohort linked data (which includes a linkage to the discharge abstracts for the mothers and infants). The PI led the project which linked the California birth and discharge data and has confirmed that sufficient data elements are available to link to VA data. From the PI's previous project, we also have access to well developed models to control for clinical and demographic risk, to which we will add controls for veterans-specific factors. Controlling for individual level determinants and care models, we will examine reproductive outcomes for different populations as described above for a wide range of reproductive outcomes, including: use of prenatal care, pregnancy complications, fetal death, delivery complications, neonatal death, birth weight, gestational age, congenital anomalies, and other serious neonatal complications (e.g. intra-ventricular hemorrhage).
FINDINGS/RESULTS:
No results at this time. The project has just started.
IMPACT:
Identification of cohorts of veterans (male and female) who may be at increased risk for poor reproductive outcomes due to environmental exposure during military service is the first step in adapting care to address risks directly or indirectly attributable to military service. Since many of the potentially adverse pregnancy outcomes of environmental exposure can be addressed by health care interventions, the results of this project could help guide improvements in reproductive care for veterans.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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