For a study, researchers wanted to investigate the feasibility of employing measures established by the National Preconception Health and Health Care Initiative’s Clinical Workgroup to assess women’s preconception wellness in a major health care system. Researchers looked at national administrative data from the Department of Veterans Affairs (VA), including inpatient, outpatient, fee-for-service, laboratory, pharmacy, and screening data for female veterans aged 18–45 who had at least one pregnancy outcome (ectopic pregnancy, spontaneous abortion, stillbirth, or live birth) during fiscal years 2010–2015 and a VA primary care visit within 1 year before their last menstrual period (LMP). LMP was calculated based on gestational age at the time of pregnancy outcome and then used as a reference point to evaluate eight prenatal markers from the Workgroup consensus measures (eg, 3 or 12 months before LMP).
From 16,034 female veterans, we found 19,839 pregnancy outcomes. The majority of pregnancies (74.9%) resulted in a live birth; 22.6% occurred in spontaneous abortion or ectopic pregnancy, and 0.5% resulted in stillbirth. More than one-third of pregnancies (39.2%) had no evidence of prenatal treatment within 14 weeks after LMP. Obese women accounted for nearly one-third (31.2%) of all pregnancies. Smoking was found in 29.2% of pregnancies with a recent relevant screening, while depression was found in 28.4%. More than half of pregnancies in women with preexisting diabetes (57.4%) lacked proof of appropriate glycemic management. There was a significant rate of non-screening for sexually transmitted infections in the year preceding or within three months of LMP. Prenatal folic acid usage was also well documented. Exposure to six kinds of teratogenic drugs was minimal throughout the same time period.
Despite administrative data constraints, tracking indicators of prenatal wellbeing provided benchmarks for improving women’s health across health care systems and communities. Healthy weight, optimal diabetes management before pregnancy, and increased usage and recording of critical prenatal health exams were all areas for intervention to enhance female veterans’ prepregnancy wellbeing.
