Racial Disparities in Prenatal Care Utilization and Infant Small for Gestational Age Among Active Duty US Military Women.

OBJECTIVES: To examine racial disparities in prenatal care (PNC) utilization and infant small for gestational age (SGA) among active duty US military women, a population with equal access to health care and known socioeconomic status. METHODS: Department of Defense Birth and Infant Health Research program data identified active duty women with singleton live births from January 2003 through August 2015. Administrative claims data were used to define PNC utilization and infant SGA, and log-binomial regression models estimated associations with race/ethnicity. To examine whether associations between maternal race/ethnicity and infant SGA were subject to effect measure modification, respective analyses were stratified by demographic and health characteristics. RESULTS: Overall, 12.2% of non-Hispanic White women initiated PNC after the first trimester, compared with 14.8% of American Indian/Alaska Native, 15.1% of Asian/Pacific Islander, 14.2% of non-Hispanic Black, and 13.0% of Hispanic women. Infant SGA prevalence was 2.4% and 1.6% among non-Hispanic Black and White women, respectively (aRR 1.52, 95% CI 1.40-1.64). This disparity persisted across stratified analyses, particularly among non-Hispanic Black versus White women with a preeclampsia or hypertension diagnosis in pregnancy (RR 1.96, 95% CI 1.67-2.29) and those aged 35 + years at infant birth (RR 2.04, 95% CI 1.56-2.67). CONCLUSIONS FOR PRACTICE: In multiple assessments of PNC utilization and infant SGA, non-Hispanic Black military women had consistently worse outcomes than their non-Hispanic White counterparts. This suggests that equal access to health care does not eliminate racial disparities in outcomes or utilization; additional research is needed to elucidate the underlying etiology of these disparities.

Prevalence of Perinatal Depression in the Military: A Systematic Review of the Literature.

Objectives Perinatal depression (PND) has been widely studied in the general population, but has been under studied in military populations. This literature review evaluates studies of PND in military service women and spouses of military servicemen. Methods Articles from peer-reviewed journals published from January 2005 to September 2015 were included if they reported on US military women and/or spouses of military servicemen who were screened for PND symptoms during the prenatal and/or postpartum periods; and were available in English. Qualitative studies were excluded. Studies were compared and contrasted by screening instrument, screening time-period, study population, deployment status as a unique risk factor, and results. Results Ten articles were included. Studies varied greatly in methodology and use of screening instruments and screening time-period, but collectively indicate a wide prevalence range of PND symptoms in military populations. Studies also indicate deployment status as a unique risk factor associated with PND symptoms. Common methodological issues include excluding women at high risk for PND, and not reporting if adequate clinical resources were readily available to ensure appropriate diagnostic and therapeutic services treatment for women who screened positive for PND. Conclusions for Practice PND is receiving increasing attention and military populations should be studied more closely to identify this condition, and understand the complex interactions of unique risk factors associated with a military way of life in order to implement more rigorous screening and early, appropriate intervention strategies.