Variations in Perinatal Interventions and Outcomes Among Active-Duty Service Women in the U.S. Military Health System

Introduction: Adverse perinatal outcomes disproportionately affect minoritized and lower-income women in the United States and are often linked to employment, insurance, and education. This study investigated whether these disparities persist in the Military Health System (MHS) among active-duty service women (ADSW), an employed, universally insured population with at least a secondary education. Methods: This cross-sectional study used data claims of ADSW ages 17–49 with births during 2016–2023. International Classification of Diseases, 10th revision (ICD-10) diagnostic, Medicare Severity Diagnosis Related Group, and Current Procedural Terminology codes were used to identify births, perinatal outcomes, and maternal comorbidities. Analyses included descriptive statistics of patient demographics including race, rank as a proxy for socioeconomic status, and incidence of perinatal interventions and outcomes; and modified Poisson regressions assessing variation between groups. Results: There were 218, 386 births by 158, 012 ADSW in fiscal year 2016–2023, with the greatest representation among White (42.91%), Black (27.16%), and enlisted (82.63%) members. Black, Asian and Pacific Islander, and American Indian/Alaska Native women showed higher risk of preterm labor, induction of labor, and cesarean section, whereas Asian and Pacific Islander and American Indian/Alaska Native women also had higher risk of postpartum hemorrhage. Officers had a higher risk for cesarean births, perineal lacerations, postpartum hemorrhage, and high-risk pregnancy at ages 35 and older. Conclusions: In this study, ADSW of minoritized races and lower rank experienced disparities in perinatal outcomes in the MHS. Lower hemorrhage risk for Black women contrasts with national data but aligns with previous MHS studies. Further research is needed to determine the factors influencing both positive and negative outcomes for ADSW.