{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:35:30Z","timestamp":1777944930086,"version":"3.51.4"},"reference-count":56,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["CDA 20-224"],"award-info":[{"award-number":["CDA 20-224"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Veterans using Department of Veterans Affairs (VA) healthcare have a high burden of pre-pregnancy chronic disease that likely contributes to the observed high rate of pregnancy-related morbidity. Many common diseases frequently co-occur; understanding patterns of multimorbidity may inform the design and delivery of pre-pregnancy interventions to lower pregnancy morbidity risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The current study sought to identify patterns of co-occurrence of pre-pregnancy chronic disease among Veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using VA administrative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Our population included Veterans ages 18\u201345 with \u2a7e1 pregnancy outcome (ectopic, spontaneous abortion, stillbirth, and\/or live birth) during fiscal years 2010\u20132019. Presence of common chronic diseases with implications for pregnancy was detected using encounter International\n                      <jats:italic toggle=\"yes\">Classification of Diseases, 9th and 10th Revision<\/jats:italic>\n                      (ICD-9 and ICD-10) codes in the 2\u2009years prior to pregnancy. Patients were grouped based on latent class models of diagnosis patterns; two to seven latent groups were examined for model fit and clinical interpretability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We identified 56,853 pregnancies from 41,034 Veterans. More than half of pregnancies were complicated by an array of pre-pregnancy medical and mental health conditions that may negatively impact pregnancy health and contribute to adverse pregnancy outcomes. The most frequently occurring conditions included chronic pain (51.2% of pregnancies), depression (31.4%), anxiety (25.9%), and post-traumatic stress disorder (22.8%). A five-group model demonstrated the best balance between model fit and clinical interpretability. Groups included: \u201cPain and Mental Health\u201d (28%), with high prevalence of chronic pain, depression, and anxiety; \u201cPain and Metabolic\u201d (17%), high prevalence of chronic pain, obesity, and migraines; \u201cSubstance Use and Mental Health\u201d (7%), high prevalence of alcohol use disorder, depression, and post-traumatic stress disorder; \u201cLow Diagnosis\u201d (43%), lower than average prevalence of diagnoses; and \u201cHigh Complexity\u201d (5%), high prevalence of conditions across multiple physiologic systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We identified five distinct, clinically meaningful groups of Veterans based on co-occurring pre-pregnancy diseases. Tailoring interventions to these groups may address Veterans\u2019 complex pre-pregnancy health risks effectively and efficiently.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057261430209","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:05:59Z","timestamp":1773810359000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Classifying Veterans\u2019 pre-pregnancy health risks using latent class analysis"],"prefix":"10.1177","volume":"22","author":[{"given":"Deirdre A.","family":"Quinn","sequence":"first","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"},{"name":"CONVERGE, University of Pittsburgh, PA, USA"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franya","family":"Hutchins","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florentina E.","family":"Sileanu","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory T.","family":"Procario","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria K.","family":"Mor","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"},{"name":"Department of Biostatistics, School of Public Health, University of Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Marie","family":"Rosland","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, PA, USA"},{"name":"Caring for Complex Chronic Conditions Research Center, University of Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodie G.","family":"Katon","sequence":"additional","affiliation":[{"name":"Center for the Study of Healthcare Innovation, Implementation &amp; Policy (CSHIIP), VA Greater Los Angeles, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa S.","family":"Callegari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, University of Washington, Seattle, WA, USA"},{"name":"Department of Health Services, University of Washington, Seattle, WA, USA"},{"name":"Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonya","family":"Borrero","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, &amp; Promotion (CHERP), VA Pittsburgh Healthcare System, PA, USA"},{"name":"CONVERGE, University of Pittsburgh, PA, USA"},{"name":"Division of General Internal Medicine, School of Medicine, University of Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05425-5"},{"key":"e_1_3_3_3_2","volume-title":"Pregnancy-related deaths: data from Maternal Mortality Review Committees in 36 US States, 2017\u20132019","author":"Trost SL","year":"2022","unstructured":"Trost SL, Beauregard J, Chandra G, et al. 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