{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:54:10Z","timestamp":1791633250485,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019713","name":"VA Pittsburgh Healthcare System","doi-asserted-by":"publisher","award":["20\u2010224"],"award-info":[{"award-number":["20\u2010224"]}],"id":[{"id":"10.13039\/100019713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe severe maternal morbidity (SMM) among veterans with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) who use Department of Veterans Affairs (VA) health care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a secondary analysis of VA national administrative data to compare rates of SMM among veterans with and without SLE or RA. Our sample included veterans aged 18 to 45 years who had at least one pregnancy between October 2009 and September 2019 and at least one documented VA primary care visit within the year before pregnancy. <jats:italic>International Classification of Diseases, Ninth<\/jats:italic> and <jats:italic>Tenth Revision<\/jats:italic> codes were used to identify SLE, RA, and medical and mental health comorbidities within two years before pregnancy. SMM was assessed using Centers for Disease Control and Prevention definitions and included events during and up to 42 days after pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 29,713 veterans, 113 had SLE, and 92 had RA. Of these veterans, 36% with SLE and 30.4% with RA experienced a nonlive birth outcome, including stillbirth, ectopic pregnancy, and spontaneous abortion, compared with 25.2% of other veterans. Nearly 10% of veterans with SLE and 4.3% of veterans with RA experienced SMM, compared with 3.2% of other veterans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To our knowledge, this is the first study of SMM among veterans with SLE and RA. Veterans with SLE appear to have an elevated risk of SMM, and veterans with SLE and RA appear to have high rates of pregnancy loss. Our findings highlight the potential utility of comprehensive maternity care models for these veterans with SLE and RA within the VA health care system.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.70100","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T07:34:58Z","timestamp":1756798498000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Severe Maternal Morbidity During and After Pregnancy Among Veterans With Systemic Lupus Erythematosus or Rheumatoid Arthritis"],"prefix":"10.1002","volume":"7","author":[{"given":"Deirdre A.","family":"Quinn","sequence":"first","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System and University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina E.","family":"Sileanu","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory T.","family":"Procario","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-4932","authenticated-orcid":false,"given":"Mehret","family":"Birru Talabi","sequence":"additional","affiliation":[{"name":"University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.41191"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.012"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/M19-0120"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.43388"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15171"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24003"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae108"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2012.01.006"},{"key":"e_1_2_7_10_1","unstructured":"FrayneSM PhibbsCS SaechaoF et al.Sourcebook: Women Veterans in the Veterans Health Administration. Volume 4: Longitudinal Trends in Sociodemographics Utilization Health Profile and Geographic Distribution. Women's Health Evaluation Initiative Women's Health Services Veterans Health Administration Department of Veterans Affairs;2018."},{"issue":"1","key":"e_1_2_7_11_1","first-page":"650","article-title":"Pregnancy outcomes of women veterans with autoimmune disease","volume":"5","author":"Sims CA","year":"2024","journal-title":"Womens Health Rep (New Rochelle)"},{"key":"e_1_2_7_12_1","unstructured":"KatonJG TartaglioneEV EleazerJR et al.State of Reproductive Health Report Volume II: VA Reproductive Health Diagnoses and Organization of Care. Office of Women's Health Veterans Health Administration Department of Veterans Affairs;2023."},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2013.03.003"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1862"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004293"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21736"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22989"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-64732-8"},{"key":"e_1_2_7_19_1","unstructured":"Centers for Disease Control and Prevention.Identifying Severe Maternal Morbidity (SMM). May 15 2024.https:\/\/www.cdc.gov\/maternal\u2010infant\u2010health\/php\/severe\u2010maternal\u2010morbidity\/icd.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/smm\/severe\u2010morbidity\u2010ICD.htm"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004665"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003647"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2023.1046"},{"key":"e_1_2_7_23_1","unstructured":"IBM Corp.IBM SPSS Statistics for Windows Version 26.0. Published online 2018."},{"key":"e_1_2_7_24_1","unstructured":"Centers for Medicare & Medicaid Services.CMS Cell Suppression Policy.2020.https:\/\/www.hhs.gov\/guidance\/document\/cms-cell-suppression-policy"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004057"},{"key":"e_1_2_7_26_1","unstructured":"U.S. Department of Veterans Affairs.VHA Directive 1330.03(2) Maternity Health Care and Coordination. November 3 2020."}],"container-title":["ACR Open Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.70100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T08:17:55Z","timestamp":1759479475000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr2.70100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":25,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/acr2.70100"],"URL":"https:\/\/doi.org\/10.1002\/acr2.70100","archive":["Portico"],"relation":{},"ISSN":["2578-5745","2578-5745"],"issn-type":[{"value":"2578-5745","type":"print"},{"value":"2578-5745","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2025-03-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70100"}}