{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:56:05Z","timestamp":1790258165698,"version":"4.1.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5-6","funder":[{"DOI":"10.13039\/100014058","name":"Bureau of Medicine and Surgery","doi-asserted-by":"publisher","award":["60504"],"award-info":[{"award-number":["60504"]}],"id":[{"id":"10.13039\/100014058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Department of Defense Birth and Infant Health Research (BIHR) program regularly identifies live births among TRICARE beneficiaries (i.e., United States military-connected families) for epidemiologic surveillance and research purposes. Linkage of infants with their TRICARE sponsor and birth mother (who may also be the sponsor) provides the capability to examine parental and military characteristics of births and associated health outcomes. The current study describes BIHR data methodology and presents population characteristics for a recent, 6-year cohort of live births among military families.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>The study cohort comprised all infants in BIHR data born January 2016 through December 2021. Same-sex multiples were not captured because of difficulty differentiating their neonatal medical records. Infants were identified and linked with sponsors and birth mothers using data from the Military Health System Data Repository and Defense Manpower Data Center, which were also used to derive demographic, military, and medical characteristics. Birth and infant health outcomes were ascertained using diagnosis and procedure codes from medical encounter files, which encompassed all care covered by TRICARE (i.e., across military and civilian facilities). Population characteristics were reported using descriptive statistics, overall and by birth mother beneficiary type: sponsor, dependent spouse, or other. Trends in selected adverse outcomes were also described (i.e., cesarean delivery, preterm birth [&amp;lt;37 weeks\u2019 gestation], low birthweight [&amp;lt;2500 g], and birth defects).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 632,565 live births identified from 2016 to 2021; birth mother beneficiary type was most frequently dependent spouse (78.0%, n\u2009=\u2009493,183), followed by sponsor (17.3%, n\u2009=\u2009109,293) and other (4.8%, n\u2009=\u200930,089). Overall, mean maternal age at delivery was 28.4 years; the majority of infants had sponsors who were married (89.3%, n\u2009=\u2009564,999), non-Hispanic White (60.7%, n\u2009=\u2009384,148), on active duty status (73.1%, n\u2009=\u2009462,107), and of any enlisted rank (79.6%, n\u2009=\u2009503,848). Most infants\u2019 sponsors deployed at least once before their birth (57.0%, n\u2009=\u2009360,312), with a smaller proportion deployed during pregnancy (7.5%, n\u2009=\u200947,306). Births were more likely to occur at civilian versus military hospitals, and the proportion of births at civilian hospitals increased over the study period, from 61.6% in 2016 to 69.5% in 2021. Among all infants, 28.2% (n\u2009=\u2009178,589) were delivered by cesarean, 7.3% (n\u2009=\u200945,940) were preterm, 5.2% (n\u2009=\u200932,605) were low birthweight, and 3.4% (n\u2009=\u200921,222) were diagnosed with a major structural birth defect in the first year of life; all of these outcomes were more likely to occur among civilian versus military hospital births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, BIHR data comprise a large number of live births with distinct parental demographic and exposure characteristics. Data can be leveraged to examine adverse health outcomes and various aspects of health care delivery among infants born to United States military-connected families.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf474","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T12:00:43Z","timestamp":1757592043000},"page":"e1207-e1216","source":"Crossref","is-referenced-by-count":3,"title":["The Department of Defense Birth and Infant Health Research Program: Characteristics of Live Births and Adverse Birth and Infant Health Outcomes Among TRICARE Beneficiaries, 2016-2021"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0587-1000","authenticated-orcid":false,"given":"Clinton","family":"Hall","sequence":"first","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4621-7227","authenticated-orcid":false,"given":"Anna T","family":"Bukowinski","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0817-9156","authenticated-orcid":false,"given":"Monica","family":"Burrell","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9341-0904","authenticated-orcid":false,"given":"Gia R","family":"Gumbs","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3364-5011","authenticated-orcid":false,"given":"Zeina G","family":"Khodr","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1117-6733","authenticated-orcid":false,"given":"Jackielyn","family":"Lanning","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3130-3024","authenticated-orcid":false,"given":"Sandra","family":"Maduforo","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7798-5333","authenticated-orcid":false,"given":"Celeste J","family":"Romano","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]},{"name":"Leidos, Inc , San Diego, CA 92101,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4007-3330","authenticated-orcid":false,"given":"Ava Marie S","family":"Conlin","sequence":"additional","affiliation":[{"name":"Deployment Health Research Department, Naval Health Research Center , San Diego, CA 92106,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"2026050517480133200_usaf474-B1","doi-asserted-by":"publisher","first-page":"S26","DOI":"10.1002\/tera.1081","article-title":"The department of defense birth defects registry: overview of a new surveillance system","volume":"64","author":"Ryan","year":"2001","journal-title":"Teratology"},{"key":"2026050517480133200_usaf474-B2","doi-asserted-by":"publisher","first-page":"126894","DOI":"10.1016\/j.vaccine.2025.126894","article-title":"COVID-19 vaccine initiation in pregnancy and risk for adverse neonatal outcomes among United States military service members, January-December 2021","volume":"51","author":"Hall","year":"2025","journal-title":"Vaccine"},{"key":"2026050517480133200_usaf474-B3","doi-asserted-by":"publisher","first-page":"6553","DOI":"10.1016\/j.vaccine.2021.09.003","article-title":"History of pandemic H1N1-containing influenza vaccination and risk for spontaneous abortion and birth defects","volume":"39","author":"Romano","year":"2021","journal-title":"Vaccine"},{"key":"2026050517480133200_usaf474-B4","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1038\/s41372-023-01633-4","article-title":"The association of regional perinatal risk factors and neonatal intensive care capacity for military health system-insured newborns","volume":"43","author":"Goodman","year":"2023","journal-title":"J Perinatol"},{"key":"2026050517480133200_usaf474-B5","doi-asserted-by":"publisher","first-page":"e1159","DOI":"10.1093\/milmed\/usaf043","article-title":"Neonatal intensive care outcomes in the military health system: comparison of military and civilian hospital births","volume":"190","author":"Mu","year":"2025","journal-title":"Mil Med"},{"key":"2026050517480133200_usaf474-B6","doi-asserted-by":"publisher","first-page":"usaf069","DOI":"10.1093\/milmed\/usaf069","article-title":"Parental mental health conditions and infant health outcomes among military families","volume":"12","author":"Bukowinski","year":"2025","journal-title":"Mil Med"},{"key":"2026050517480133200_usaf474-B7","doi-asserted-by":"publisher","first-page":"9053","DOI":"10.1080\/14767058.2021.2013796","article-title":"Pregnancy and posttraumatic stress disorder: associations with infant outcomes and prenatal care utilization","volume":"35","author":"Lutgendorf","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2026050517480133200_usaf474-B8","author":"Dave Philipps","year":"2020"},{"key":"2026050517480133200_usaf474-B9","author":"Thompson","year":"2016"},{"key":"2026050517480133200_usaf474-B10","year":"2018"},{"key":"2026050517480133200_usaf474-B11","year":"2025"},{"key":"2026050517480133200_usaf474-B12","year":"2022"},{"key":"2026050517480133200_usaf474-B13","first-page":"39","article-title":"Department of defense birth and infant health registry: select reproductive health outcomes, 2003-2014","volume":"24","author":"Bukowinski","year":"2017","journal-title":"MSMR"},{"key":"2026050517480133200_usaf474-B14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17218031","article-title":"Pediatrics consequences of caesarean Section-A systematic review and meta-analysis","volume":"17","author":"S\u0142abuszewska-J\u00f3\u017awiak","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026050517480133200_usaf474-B15","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.clp.2017.01.003","article-title":"Long-Term impact of preterm birth: neurodevelopmental and physical health outcomes","volume":"44","author":"Luu","year":"2017","journal-title":"Clin Perinatol"},{"key":"2026050517480133200_usaf474-B16","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/s2213-2600(23)00272-2","article-title":"Unravelling the respiratory health path across the lifespan for survivors of preterm birth","volume":"12","author":"Simpson","year":"2024","journal-title":"Lancet Respir Med"},{"key":"2026050517480133200_usaf474-B17","author":"CDC"},{"key":"2026050517480133200_usaf474-B18","doi-asserted-by":"publisher","first-page":"e2301","DOI":"10.1002\/bdr2.2301","article-title":"National population-based estimates for major birth defects, 2016-2020","volume":"116","author":"Stallings","year":"2024","journal-title":"Birth Defects Res"},{"key":"2026050517480133200_usaf474-B19","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1053\/j.semperi.2017.07.004","article-title":"The prevalence of selected major birth defects in the United States","volume":"41","author":"Kirby","year":"2017","journal-title":"Semin Perinatol"},{"key":"2026050517480133200_usaf474-B20","first-page":"2","article-title":"Offspring sex ratio of male active duty U.S. Navy submariners, 2001-2015","volume":"26","author":"Hall","year":"2019","journal-title":"MSMR"},{"key":"2026050517480133200_usaf474-B21","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1080\/19338244.2020.1760191","article-title":"Infant health outcomes among offspring of male U.S. military divers","volume":"75","author":"Hall","year":"2020","journal-title":"Arch Environ Occup Health"},{"key":"2026050517480133200_usaf474-B22","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1097\/JOM.0b013e31824fe154","article-title":"Birth outcomes among military personnel after exposure to documented open-air burn pits before and during pregnancy","volume":"54","author":"Conlin","year":"2012","journal-title":"J Occup Environ Med"},{"key":"2026050517480133200_usaf474-B23","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1136\/oemed-2022-108714","article-title":"Health outcomes among offspring of US Coast guard responders to the deepwater horizon oil spill, 2010-2011","volume":"80","author":"Hall","year":"2023","journal-title":"Occup Environ Med"},{"key":"2026050517480133200_usaf474-B24","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taaa138","article-title":"Safety of yellow fever vaccination in pregnancy: findings from a cohort of active duty US military women","volume":"27","author":"Hall","year":"2020","journal-title":"J Travel Med"},{"key":"2026050517480133200_usaf474-B25","doi-asserted-by":"publisher","first-page":"4529","DOI":"10.1016\/j.vaccine.2020.05.023","article-title":"Japanese encephalitis vaccination in pregnancy among U.S. active duty military women","volume":"38","author":"Khodr","year":"2020","journal-title":"Vaccine"},{"key":"2026050517480133200_usaf474-B26","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.jad.2019.11.006","article-title":"Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery","volume":"262","author":"Gelaye","year":"2020","journal-title":"J Affect Disord"},{"key":"2026050517480133200_usaf474-B27","doi-asserted-by":"publisher","first-page":"108.e1","DOI":"10.1016\/j.ajog.2021.07.007","article-title":"Trajectories of antenatal depression and adverse pregnancy outcomes","volume":"226","author":"Miller","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"2026050517480133200_usaf474-B28","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.wombi.2015.02.003","article-title":"The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: a systematic review","volume":"28","author":"Staneva","year":"2015","journal-title":"Women Birth"},{"key":"2026050517480133200_usaf474-B29","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1093\/aje\/kwy003","article-title":"Deployment and preterm birth among US army soldiers","volume":"187","author":"Shaw","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2026050517480133200_usaf474-B30","first-page":"2","article-title":"Diagnoses of mental health disorders among active component U.S. Armed forces, 2019-2023","volume":"31","author":"Armed Forces Health Surveillance D","year":"2024","journal-title":"MSMR"},{"key":"2026050517480133200_usaf474-B31","author":"Department of Defense Releases Annual Demographics Report\u2013Upward Trend in Number of Women Serving Continues","year":"2022"},{"key":"2026050517480133200_usaf474-B32","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024-069653","article-title":"Incidence of medical complexity in military-connected children","volume":"155","author":"Leyenaar","year":"2025","journal-title":"Pediatrics"},{"key":"2026050517480133200_usaf474-B33","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2023-064965","article-title":"Vaccine completion and timeliness among children in the military health system: 2010-2019","volume":"154","author":"Romano","year":"2024","journal-title":"Pediatrics"},{"key":"2026050517480133200_usaf474-B34","doi-asserted-by":"publisher","first-page":"1280","DOI":"10.1002\/pds.5659","article-title":"Validation of diagnosis codes for chorioamnionitis in medical encounter data, 2013-2018","volume":"32","author":"Hall","year":"2023","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026050517480133200_usaf474-B35","doi-asserted-by":"publisher","first-page":"e2305","DOI":"10.1002\/bdr2.2305","article-title":"Investigation of a transient increase in omphalocele prevalence in a birth cohort of TRICARE beneficiaries","volume":"116","author":"Lanning","year":"2024","journal-title":"Birth Defects Res"},{"key":"2026050517480133200_usaf474-B36","doi-asserted-by":"publisher","first-page":"e2265","DOI":"10.1002\/bdr2.2265","article-title":"Validation of ICD-9-CM codes for major genitourinary birth defects in military health system administrative data, 2006-2014","volume":"116","author":"Romano","year":"2024","journal-title":"Birth Defects Res"},{"key":"2026050517480133200_usaf474-B37"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/5-6\/e1207\/64464259\/usaf474.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/5-6\/e1207\/64464259\/usaf474.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T22:18:36Z","timestamp":1778019516000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/5-6\/e1207\/8270637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":37,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2025,9,29]]},"published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf474","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2025,9,29]]}}}