510 - Pregnancy and Delivery Outcomes in Adolescent and Young Adult Mothers in the Military Health System

Poster Number: 510
Publication Number: 510.100

Saira Ahmed, Brooke Army Medical Center, SAN ANTONIO, TX, United States; Rasheda J. Vereen, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Fort Sam Houston, TX, United States; James K. Aden, US Army GME, Ft Sam Houston, TX, United States; Christopher A. Dillon, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, San Antonio, TX, United States; Jonathan Shapiro, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Ft Sam Houston, TX, United States; Dakota Tomasini, SAUSHEC, San Antonio, TX, United States

Background: Adolescent mothers are at higher risk for poor prenatal care (PNC), and adverse pregnancy, delivery, and neonatal outcomes. Women with health insurance are more likely to seek preventative services for pregnancy and childbirth. With the passing of the Affordable Care Act (ACA) in 2010, military dependent children may remain covered as military insurance beneficiaries until age 26.

Objective: We aim to examine adverse pregnancy and delivery outcomes in military-connected adolescent and young adult (AYA) mothers after ACA implementation.

Design/Methods: Dependent daughter (DD), active duty (AD) spouse, and AD service member (ADSM) mothers under age 26 within the San Antonio Military Health System (SAMHS) at their initial prenatal visit receiving care between 2015-2019 were included. Data was collected retrospectively from inpatient and outpatient records. Demographic data included age at first prenatal visit, marital status, beneficiary status, sponsor rank, and estimated gestational age (EGA) at first prenatal visit and birth. Records were reviewed for preeclampsia (PrE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), premature labor, substance use, sexually transmitted infection (STI), elective abortion, and pregnancy loss. Maternal outcomes were compared to the demographic data.

Results: There were 4557 eligible mothers ages 13 to 26. About 75% of mothers were married. Median age at first prenatal visit was 20 years for unwed and 23 years for married mothers. DD, ADSM, and AD spouses made up 16%, 29%, and 55% of mothers, respectively. Age at initial prenatal visit and beneficiary status was not significantly associated with PrE, premature labor, PROM (Table 1). Younger age, DD, later initial prenatal visit, and enlisted rank was associated with STI. Delayed entry to PNC was significantly associated with PrE, GDM, substance use, STI, DD, and younger age (Tables 1-2). Age, beneficiary status, and initial prenatal visit trimester was significantly associated with EGA at birth (Table 2).Conclusion(s): PNC initiation in the first trimester within the SAMHS is consistent with national data. Younger age and DD status are associated with delayed initiation of PNC. However, younger maternal age is not associated with certain adverse pregnancy and delivery outcomes in military-connected mothers. This may indicate that universal access to healthcare may improve AYA pregnancy and delivery outcomes.
Saira Ahmed CV December 2021.pdf
Presentation to Prenatal Care and Estimated Gestational Age at Birtha) AD = active duty, b) ADSM = active duty service member, c) EGA = estimated gestational age