{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:54:16Z","timestamp":1760162056147,"version":"3.28.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"02","funder":[{"name":"U.S. Navy Bureau of Medicine and Surgery under work unit no. 60504"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to assess trends and correlates of severe maternal morbidity at delivery among active duty women in the U.S. military, all of whom are guaranteed health care and full employment.<\/jats:p><jats:p>\n            Study Design\u2003Linked military personnel and medical encounter data from the Department of Defense Birth and Infant Health Research program were used to identify a cohort of delivery hospitalizations among active duty military women from January 2003 through August 2015. Cases of severe maternal morbidity were identified by applying 21- and 20-condition algorithms (with and without blood transfusion) developed by the Centers for Disease Control and Prevention. Rates (per 10,000 delivery hospitalizations) were reported overall and by specific condition. Multivariable Poisson regression models estimated associations with demographic, clinical, and military characteristics.<\/jats:p><jats:p>\n            Results\u2003Overall, 187,063 hospitalizations for live births were included for analyses. The overall 21- and 20-condition severe maternal morbidity rates were 111.7 (n\u2009=\u20092089) and 37.4 (n\u2009=\u2009699) per 10,000 delivery hospitalizations, respectively. The 21-condition rate increased by 184% from 2003 to 2015; the 20-condition rate increased by 40%. Compared with non-Hispanic White women, the adjusted 21-condition rate of severe maternal morbidity was higher for Hispanic (adjusted rate ratio [aRR]\u2009=\u20091.28, 95% confidence interval [CI]: 1.13\u20131.46), non-Hispanic Black (aRR\u2009=\u20091.34, 95% CI: 1.21\u20131.49), Asian\/Pacific Islander (aRR\u2009=\u20091.35, 95% CI: 1.13\u20131.61), and American Indian\/Alaska Native (aRR\u2009=\u20091.39, 95% CI: 1.06\u20131.82) women. Rates also varied by age, clinical factors, and deployment history.<\/jats:p><jats:p>\n            Conclusion\u2003Active duty U.S. military women experienced an increase in severe maternal morbidity from 2003 to 2015 that followed national trends, despite protective factors such as stable employment and universal health care. Similar to other populations, military women of color were at higher risk for severe maternal morbidity relative to non-Hispanic White military women. Continued surveillance and further investigation into maternal health outcomes are critical for identifying areas of improvement in the Military Health System.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1740248","type":"journal-article","created":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:05:49Z","timestamp":1639181149000},"page":"150-159","source":"Crossref","is-referenced-by-count":3,"title":["Severe Maternal Morbidity among Women in the U. S. Military, 2003\u20132015"],"prefix":"10.1055","volume":"41","author":[{"given":"Clinton","family":"Hall","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center, San Diego, California"},{"name":"Leidos Inc., San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celeste J.","family":"Romano","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center, San Diego, California"},{"name":"Leidos Inc., San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna T.","family":"Bukowinski","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center, San Diego, California"},{"name":"Leidos Inc., San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gia R.","family":"Gumbs","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center, San Diego, California"},{"name":"Leidos Inc., San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlyn N.","family":"Dempsey","sequence":"additional","affiliation":[{"name":"School of Medicine, Uniformed Services University, Bethesda, Maryland"},{"name":"Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron T.","family":"Poole","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia"},{"name":"Las Palmas Del Sol Healthcare, El Paso, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ava Marie S.","family":"Conlin","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon V.","family":"Lamb","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,12,10]]},"reference":[{"volume-title":"2019 Demographics Report: Profile of the Military Community","year":"2019","key":"ref1"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jogn.2018.10.009","article-title":"Scoping review and gap analysis of research related to the health of women in the U.S. military, 2000 to 2015","volume":"48","author":"R M Englert","year":"2019","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/AOG.0000000000002432","article-title":"Estimating the hospital delivery costs associated with severe maternal morbidity in New York City, 2008\u20132012","volume":"131","author":"R E Howland","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"13","key":"ref4","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1055\/s-0038-1649481","article-title":"Severe maternal morbidity and hospital cost among hospitalized deliveries in the United States","volume":"35","author":"H Y Chen","year":"2018","journal-title":"Am J Perinatol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jpeds.2019.07.061","article-title":"The impact of severe maternal morbidity on very preterm infant outcomes","volume":"215","author":"J Zeitlin","year":"2019","journal-title":"J Pediatr"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.ijgo.2015.10.027","article-title":"A cohort study of functioning and disability among women after severe maternal morbidity","volume":"134","author":"C Silveira","year":"2016","journal-title":"Int J Gynaecol Obstet"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.amepre.2012.01.006","article-title":"Health indicators for military, veteran, and civilian women","volume":"42","author":"K Lehavot","year":"2012","journal-title":"Am J Prev Med"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1055\/s-0039-1678751","article-title":"The Department of Defense Birth and Infant Health Research program: assessing the reproductive health of U.S. active-duty women","volume":"36","author":"Z G Khodr","year":"2018","journal-title":"Semin Reprod Med"},{"issue":"11","key":"ref11","first-page":"39","article-title":"Department of Defense Birth and Infant Health Registry: select reproductive health outcomes, 2003-2014","volume":"24","author":"A T Bukowinski","year":"2017","journal-title":"MSMR"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/AOG.0b013e31826d60c5","article-title":"Severe maternal morbidity among delivery and postpartum hospitalizations in the United States","volume":"120","author":"W M Callaghan","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"643.e1","DOI":"10.1016\/j.ajog.2015.11.004","article-title":"Measuring severe maternal morbidity: validation of potential measures","volume":"214","author":"E K Main","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"435.e1","DOI":"10.1016\/j.ajog.2013.11.039","article-title":"Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010","volume":"210","author":"A A Creanga","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1097\/AOG.0000000000002937","article-title":"Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012\u20132015","volume":"132","author":"L K Admon","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"07","key":"ref17","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s10995-020-02941-3","article-title":"Racial disparities in prenatal care utilization and infant small for gestational age among active duty US military women","volume":"24","author":"C Hall","year":"2020","journal-title":"Matern Child Health J"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1177\/0962280211427759","article-title":"Extension of the modified Poisson regression model to prospective studies with correlated binary data","volume":"22","author":"G Y Zou","year":"2013","journal-title":"Stat Methods Med Res"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/ppe.12011","article-title":"Population-based study of risk factors for severe maternal morbidity","volume":"26","author":"K E Gray","year":"2012","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"353.e1","DOI":"10.1016\/j.ajog.2010.01.011","article-title":"Trends in postpartum hemorrhage: United States, 1994-2006","volume":"202","author":"W M Callaghan","year":"2010","journal-title":"Am J Obstet Gynecol"},{"volume-title":"Final Report to the Secretary of Defense: Military Health System Review","year":"2014","key":"ref22"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/AOG.0000000000000054","article-title":"Blood transfusion during pregnancy, birth, and the postnatal period","volume":"123","author":"J A Patterson","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12884-018-2169-3","article-title":"The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity","volume":"19","author":"S A Leonard","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"582","DOI":"10.3390\/jcm9020582","article-title":"A population-based study of diabetes during pregnancy in Spain (2009\u20132015): trends in incidence, obstetrics interventions, and pregnancy outcomes","volume":"9","author":"A L\u00f3pez-de-Andr\u00e9s","year":"2020","journal-title":"J Clin Med"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1097\/AOG.0b013e3181a45b25","article-title":"Hypertensive disorders and severe obstetric morbidity in the United States","volume":"113","author":"E V Kuklina","year":"2009","journal-title":"Obstet Gynecol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"100657","DOI":"10.1016\/j.eclinm.2020.100657","article-title":"Concerning trends in maternal risk factors in the United States: 1989\u20132018","volume":"29","author":"E Bornstein","year":"2020","journal-title":"EClinicalMedicine"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-white differences in severe maternal morbidity and site of care","volume":"214","author":"E A Howell","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"795.e1","DOI":"10.1016\/j.ajog.2016.07.039","article-title":"Hospital delivery volume, severe obstetrical morbidity, and failure to rescue","volume":"215","author":"A M Friedman","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref32","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1038\/s41372-018-0096-9","article-title":"Severe maternal morbidity and related hospital quality measures in Maryland","volume":"38","author":"L D Reid","year":"2018","journal-title":"J Perinatol"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/AOG.0000000000003667","article-title":"Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities","volume":"135","author":"E A Howell","year":"2020","journal-title":"Obstet Gynecol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.annepidem.2019.02.007","article-title":"Racial and ethnic disparities in severe maternal morbidity prevalence and trends","volume":"33","author":"S A Leonard","year":"2019","journal-title":"Ann Epidemiol"},{"issue":"06","key":"ref35","doi-asserted-by":"crossref","first-page":"557.e1","DOI":"10.1016\/j.ajog.2013.12.032","article-title":"Preventability of severe acute maternal morbidity","volume":"210","author":"B Lawton","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s12978-018-0527-2","article-title":"A global view of severe maternal morbidity: moving beyond maternal mortality","volume":"15","author":"S E Geller","year":"2018","journal-title":"Reprod Health"},{"issue":"04","key":"ref37","doi-asserted-by":"crossref","first-page":"509.e1","DOI":"10.1016\/j.ajog.2016.05.022","article-title":"Opportunities for improvement in care among women with severe maternal morbidity","volume":"215","author":"J A Ozimek","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1111\/ppe.12610","article-title":"Validation of criteria to identify severe maternal morbidity","volume":"34","author":"K P Himes","year":"2020","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1097\/AOG.0000000000003528","article-title":"Association between stillbirth at 23 weeks of gestation or greater and severe maternal morbidity","volume":"134","author":"A K Lewkowitz","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref40","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/AOG.0000000000003370","article-title":"Severe maternal morbidity among stillbirth and live birth deliveries in California","volume":"134","author":"E Wall-Wieler","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"10","key":"ref41","doi-asserted-by":"crossref","first-page":"695","DOI":"10.7326\/M13-2844","article-title":"Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force","volume":"160","author":"J T Henderson","year":"2014","journal-title":"Ann Intern Med"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1097\/AOG.0000000000002708","article-title":"Low-dose aspirin use during pregnancy. ACOG committee opinion no. 743","volume":"132","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1740248.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T10:14:49Z","timestamp":1730801689000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1740248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,10]]},"references-count":36,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2024,1,16]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1740248","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"type":"print","value":"0735-1631"},{"type":"electronic","value":"1098-8785"}],"subject":[],"published":{"date-parts":[[2021,12,10]]}}}