Severe maternal morbidity and potential disparities by race and rurality among VA-covered births, 2010 to 2020

Abstract: Maternal mortality and severe maternal morbidity (SMM) are increasing in the United States, with disparities noted by race and rurality. This study examined trends in Veterans Health Administration (VA)-covered births (2010–2020), focusing on SMM rates and disparities by race and rurality. VA-covered births more than doubled during this period, with a 2.6-fold increase among Black veterans. Unadjusted SMM rates nearly doubled, driven primarily by obstetrical comorbidities, which explained racial disparities in SMM. Black veterans had 38% higher unadjusted SMM rates than White veterans, but this disparity was eliminated after adjusting for comorbidities. Rurality showed nonsignificant elevation of risk. Mental health conditions and maternal age were key contributors to SMM. Findings underscore the importance of timely management of obstetrical comorbidities and equitable mental health care to reduce SMM and racial disparities. VA’s equal-access health system may mitigate disparities compared to non-VA systems, warranting further research on obstetrical comorbidities and rural–urban differences among pregnant veterans.

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