Pregnancy and mental health care among women veterans returning from Iraq and Afghanistan

Background: Women veterans comprise a growing proportion of new patients in the Veterans Administration (VA) Healthcare system. Many require reproductive health services, including care for pregnancy, and ongoing mental health services for combat-related trauma. Little is known regarding the mental health needs of pregnant women veterans or how many women utilize the VA or its affiliated providers for obstetrical care.

Objective: This study aims to investigate the occurrence of pregnancy, and concurrent mental health problems, among women veterans who utilize VA health services.

Methods: 44,264 files of women who served in Iraq and Afghanistan and enrolled in VA health care after return from deployment were reviewed. Cross-sectional analyses of veteran women who have enrolled in VA health care were performed.

Results: 940 women (2%) requested military separation due to pregnancy. Of these women, 88 (9%) sought pregnancy care in the VA. During the six-year study period, there were 2036 pregnancies among veterans in VA care, while 102 (5%) ended in miscarriage or spontaneous abortion, while another 46 (2%) were ectopic or molar pregnancies. Compared to non-pregnant veterans utilizing VA care, pregnant veterans were more likely to have a diagnosis of PTSD (16% vs 12%, p<.0001), major depression (7.5% vs. 5.7%, p<.001), and mild depression (15% vs. 11%, p<.0001). Only 54% of all pregnancies had documentation of VA payment through VA fee basis mechanisms, either as an inpatient or outpatient.

Conclusions: Pregnancy is common among women veterans, and many pregnant women seeking care in the VA have concomitant mental health problems.