Severe Complications for Pregnant Veterans Nearly Doubled in the Last Decade, a GAO Report Finds
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After the Supreme Court overturned Roe v. Wade, ending nearly 50 years of federal protection for abortion, some states began enforcing strict abortion bans while others became new havens for the procedure. ProPublica is investigating how sweeping changes to reproductive health care access in America are affecting people, institutions and governments.
Over the past decade, the rate of veterans suffering severe pregnancy complications has risen dramatically, a new federal report found.
Veterans have raced to the hospital with dangerous infections, kidney failure, aneurysms or blood loss. They’ve required hysterectomies, breathing machines and blood transfusions to save their lives. Between 2011 and 2020, 13 veterans died after such complications.
The report found that among people getting health care benefits through the Department of Veterans Affairs, the rate of severe complications nearly doubled during that time, from about 93 per 10,000 hospitalizations in 2011 to just over 184 per 10,000 hospitalizations in 2020. Black veterans had the highest rates.
The report, which was put together by the Government Accountability Office, also made recommendations for reducing the problem, which focus on conducting more routine screenings throughout pregnancy and in the postpartum period.
“It is imperative that the VA help ensure veterans have the healthiest pregnancy outcomes possible,” the report said, highlighting the increasing number of veterans using the agency’s maternity benefits as well as the troublesome complication rates faced by Black women.
The report’s findings are an unfortunate trend, said Alyssa Hundrup, director of health care at the GAO. The office analyzed data on 40,000 hospitalizations related to deliveries paid for by the VA. It captures a time period before 21 states banned or greatly restricted abortion and the military was thrust into a political battle over whether it would pay for active service members to travel for abortion care if a pregnancy was a risk to their health.
Hundrup, who led the review, said the analysis included hospital records from days after delivery to a year postpartum. The report was mandated after Congress passed a law in 2021 that aimed to address the maternal health crisis among veterans. The law led to a $15 million investment in maternity care coordination programs for veterans.
The report recommended that the VA analyze and collect more data on severe complications as well as data on the mental health, race and ethnicity of veterans who experience complications to understand the causes behind the increase and the reasons for the disparity. The report also states that oversight is needed to ensure screenings are being completed.
Studies show there’s a connection between mental health conditions and pregnancy-related complications, VA officials said.
The report recommended expanding the screening questions that providers ask patients at appointments to glean more information about their mental health, including anxiety and PTSD symptoms. It urged the VA to review the data more regularly.
“You don’t know what you don’t measure,” Hundrup said in an interview with ProPublica.
The VA health system, which historically served a male population, does not provide maternity care at its facilities. Instead, the agency has outsourced maternity care. But when patients were treated by those providers, the VA failed to track whether they were getting screened for other health issues and mental health problems.
Officials hope the improved data collection will help the VA study underlying issues that may lead to complications. For example, do higher rates of anxiety have a connection to rates of high blood pressure in pregnant people?
VA officials are working with a maternal health review committee to monitor the data as it is gathered. The agency recently conducted its first review of data going back five years about pregnancy-related complications, said Dr. Amanda Johnson, acting head of the VA’s Office of Women’s Health, who is overseeing the implementation of the report’s recommendations.
The VA has created a dashboard to monitor pregnant veterans’ health outcomes. The VA’s data analysis team will also examine the impact of veterans’ ages on complications and whether they differ for people who live in urban and rural areas.
VA officials will begin to review mental health screenings conducted by maternal care coordinators in March. The coordinators advocate for veterans, helping them between health care visits, whether their providers are inside or outside the VA.
Johnson said that reducing racial and ethnic disparities is a priority for the agency. In 2018, ProPublica published “Lost Mothers,” a series that shed light on the country’s maternal health crisis. Studies have shown that in the general population, Black women are three times more likely than white women to die from pregnancy-related complications. While deaths made up only a small portion of the bad outcomes for Black veterans cited in the report, VA care could not spare them from elevated rates of severe complications. Johnson said the maternal health crisis also persists within the VA.
“There is a disparity,” Johnson said. “We are not immune to that.”
Research shows pregnant people who have used the VA’s coverage have higher rates of trauma and mental conditions that can increase their risks of complications and bad outcomes.
This may be because many people who join the military enter it having already faced trauma, said Dr. Laura Miller, a psychiatrist and the medical director of reproductive mental health at the VA.
She said veterans with PTSD have higher rates of complications such as preeclampsia, a potentially fatal condition related to high blood pressure, gestational diabetes and postpartum depression. If untreated during pregnancy, depression also increases the likelihood of preterm birth and lingering problems for babies.
Hundrup said she hopes this proactive work will improve maternal health.
“We want these numbers trending in the other direction,” Hundrup said.
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Do You Believe In Magic? – by Dr. Paul Offit
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Here at 10almonds, we like to examine and present the science wherever it leads, so this book was an interesting read.
Dr. Offit, himself a much-decorated vaccine research scientist, and longtime enemy of the anti-vax crowd, takes aim at alternative therapies in general, looking at what does work (and how), and what doesn’t (and what harm it can cause).
The style of the book is largely polemic in tone, but there’s lots of well-qualified information and stats in here too. And certainly, if there are alternative therapies you’ve left unquestioned, this book will probably prompt questions, at the very least.
And science, of course, is about asking questions, and shouldn’t be afraid of such! Open-minded skepticism is a key starting point, while being unafraid to actually reach a conclusion of “this is probably [not] so”, when and if that’s where the evidence brings us. Then, question again when and if new evidence comes along.
To that end, Dr. Offit does an enthusiastic job of looking for answers, and presenting what he finds.
If the book has downsides, they are primarily twofold:
- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
- His keenness here seems to step from a desire to ensure people don’t skip life-saving medical treatments in the hope that their diet will cure their cancer (or liver disease, or be it what it may), but in doing so, he throws out a lot of actually good science.
- He—strangely—lumps menopausal HRT in with alternative therapies, and does the exact same kind of anti-science scaremongering that he rails against in the rest of the book.
- In his defence, this book was published ten years ago, and he may have been influenced by a stack of headlines at the time, and a popular celebrity endorsement of HRT, which likely put him off it.
Bottom line: there’s something here to annoy everyone—which makes for stimulating reading.
Click here to check out Do You Believe In Magic, and expand your knowledge!
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- He is a little quick to dismiss the benefits of a good healthy diet, supplemented or otherwise.
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Why Some People Get Sick More (And How To Not Be One Of Them)
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Some people have never yet had COVID (so far so good, this writer included); others are on their third bout already; others have not been so lucky and are no longer with us to share their stories.
Obviously, even the healthiest and/or most careful person can get sick, and it would be folly to be complacent and think “I’m not a person who gets sick; that happens to other people”.
Nor is COVID the only thing out there to worry about; there’s always the latest outbreak-du-jour of something, and there are always the perennials such as cold and flu—which are also not to be underestimated, because both weaken us to other things, and flu has killed very many, from the 50,000,000+ in the 1918 pandemic, to the 700,000ish that it kills each year nowadays.
And then there are the combination viruses:
Move over, COVID and Flu! We Have “Hybrid Viruses” To Contend With Now
So, why are some people more susceptible?
Firstly, some people are simply immunocompromised. This means for example that:
- perhaps they have an inflammatory/autoimmune disease of some kind (e.g. lupus, rheumatoid arthritis, type 1 diabetes), or…
- perhaps they are taking immunosuppressants for some reason (e.g. because they had an organ transplant), or…
- perhaps they have a primary infection that leaves them vulnerable to secondary infections. Most infections will do this to some degree or another, but some are worse for it than others; untreated HIV is a clear example. The HIV itself may not kill people, but (if untreated) the resultant AIDS will leave a person open to being killed by almost any passing opportunistic pathogen. Pneumonia of various kinds being high on the list, but it could even be something as simple as the common cold, without a working immune system to fight it.
See also: How To Prevent (Or Reduce) Inflammation
And for that matter, since pneumonia is a very common last-nail-in-the-coffin secondary infection (especially: older people going into hospital with one thing, getting a secondary infection and ultimately dying as a result), it’s particularly important to avoid that, so…
See also: Pneumonia: What We Can & Can’t Do About It
Secondly, some people are not immunocompromised per the usual definition of the word, but their immune system is, arguably, compromised.
Cortisol, the stress hormone, is an immunosuppressant. We need cortisol to live, but we only need it in small bursts here and there (such as when we are waking up the morning). When high cortisol levels become chronic, so too does cortisol’s immunosuppressant effect.
Top things that cause elevated cortisol levels include:
- Stress
- Alcohol
- Smoking
Thus, the keys here are to 1) not smoke 2) not drink, ideally, or at least keep consumption low, but honestly even one drink will elevate cortisol levels, so it’s better not to, and 3) manage stress.
See also: Lower Your Cortisol! (Here’s Why & How)
Other modifiable factors
Being aware of infection risk and taking steps to reduce it (e.g. avoiding being with many people in confined indoor places, masking as appropriate, handwashing frequently) is a good preventative strategy, along with of course getting any recommended vaccines as they come available.
What if they fail? How can we boost the immune system?
We talked about not sabotaging the immune system, but what about actively boosting it? The answer is yes, we certainly can (barring serious medical reasons why not), as there are some very important lifestyle factors too:
Beyond Supplements: The Real Immune-Boosters!
One final last-line thing…
Since if we do get an infection, it’s better to know sooner rather than later… A recent study shows that wearable activity trackers can (if we pay attention to the right things) help predict disease, including highlighting COVID status (positive or negative) about as accurately (88% accuracy) as rapid screening tests. Here’s a pop-science article about it:
Wearable activity trackers show promise in detecting early signals of disease
Take care!
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Lose Weight, But Healthily
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What Do You Have To Lose?
For something that’s a very commonly sought-after thing, we’ve not yet done a main feature specifically about how to lose weight, so we’re going to do that today, and make it part of a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
And yes, that last one is something that some people want/need to do (healthily!), and want/need help with that.
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
One reason we’ve not covered this before is because the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Important: the above does mean that for very many of our readers, weight loss would not actually be healthy.
Today’s article is intended as a guide only for those who are sure that weight loss is the correct path forward. If in doubt, please talk to your doctor.
With that in mind…
Start in the kitchen
You will not be able to exercise well if your body is malnourished.
Counterintuitively, malnourishment and obesity often go hand-in-hand, partly for this reason.
Important: it’s not the calories in your food; it’s the food in your calories
See also: Mythbusting Calories
The kind of diet that most readily produces unhealthy overweight, the diet that nutritional scientists often call the “Standard American Diet”, or “SAD” for short, is high on calories but low on nutrients.
So you will want to flip this, and focus on enjoying nutrient-dense whole foods.
The Mediterranean Diet is the current “gold standard” in this regard, so for your interest we offer:
Four Ways To Upgrade The Mediterranean Diet
And since you may be wondering:
Should You Go Light Or Heavy On Carbs?
The dining room is the next most important place
Many people do not appreciate food enough for good health. The trick here is, having prepared a nice meal, to actually take the time to enjoy it.
It can be tempting when hungry (or just plain busy) to want to wolf down dinner in 47 seconds, but that is the metabolic equivalent of “oh no, our campfire needs more fuel, let’s spray it with a gallon of gasoline”.
To counter this, here’s the very good advice of Dr. Rupy Aujla, “The Kitchen Doctor”:
Interoception & Mindful Eating
The bedroom is important too
You snooze, you lose… Visceral belly fat, anyway! We’ve talked before about how waist circumference is a better indicator of metabolic health than BMI, and in our article about trimming that down, we covered how good sleep is critical for one’s waistline:
Visceral Belly Fat & How To Lose It
Exercise, yes! But in one important way.
There are various types of exercise that are good for various kinds of health, but there’s only one type of exercise that is good for boosting one’s metabolism.
Whereas most kinds of exercise will raise one’s metabolism while exercising, and then lower it afterwards (to below its previous metabolic base rate!) to compensate, high-intensity interval training (HIIT) will raise your metabolism while training, and for two hours afterwards:
…which means that unlike most kinds of exercise, HIIT actually works for fat loss:
So if you’d like to take up HIIT, here’s how:
How (And Why) To Do HIIT (Without Wrecking Your Body)
Want more?
Check out our previous article about specifically how to…
Burn! How To Boost Your Metabolism
Take care!
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Pear vs Prickly Pear – Which is Healthier?
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Our Verdict
When comparing pear to prickly pear, we picked the prickly.
Why?
Both of these fruits are fine and worthy choices, but the prickly pear wins out in nutritional density.
Looking at the macros to start with, the prickly pear is higher in fiber and lower in carbs, resulting in a much lower glycemic index. However, non-prickly pears are already low GI, so this is not a huge matter. Whether it’s pear’s GI of 38 or prickly pear’s GI of 7, you’re unlikely to experience a glucose spike.
In the category of vitamins, pear has a little more of vitamins B5, B9, E, K, and choline, but the margins are tiny. On the other hand, prickly pear has more of vitamins A, B1, B2, B3, B6, and C, with much larger margins of difference (except vitamin B1; that’s still quite close). Even before taking margins of difference into account, this is a slight win for prickly pear.
When it comes to minerals, things are more pronounced; pear has more manganese, while prickly pear has more calcium, iron, magnesium, phosphorus, potassium, selenium, and zinc.
In short, both pears are great (so do enjoy the pair), but prickly pear is the clear winner where one must be declared.
Want to learn more?
You might like to read:
Apple vs Pear – Which is Healthier?
Take care!
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Rethinking Diabetes – by Gary Taubes
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We’ve previously reviewed this author’s “The Case Against Sugar” and “Why We Get Fat And What To Do About It“. There’s an obvious theme, and this book caps it off nicely:
By looking at the history of diabetes treatment (types 1 and 2) in the past hundred years, and analysing the patterns over time, we can see how:
- diabetics have been misled a lot over time by healthcare providers
- we can learn from those mistakes going forwards
Happily, he does this without crystal-balling the future or expecting diet to fix, for example, a pancreas that can’t produce insulin. But what he does do is focus on the “can” items rather than the “can’t” items.
In the category of criticism, one of the strategies he argues for is basically the keto diet, which is indeed just fine for diabetes but often not great for the heart in the long-term (it depends on various factors, including genes). However, even if you choose not to implement that, there is plenty more to try out in this book.
Bottom line: whether you have diabetes, love someone who does, or just plain like to be on top of your glycemic health, this book is full of important insights and opportunities to improve things progressively along the way.
Click here to check out Rethinking Diabetes, and rethink diabetes!
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Fitness In Our Fifties
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: What’s a worthwhile fitness goal for people in their 50s?
A: At 10almonds, we think that goals are great but habits are better.
If your goal is to run a marathon, that’s a fine goal, and can be very motivating, but then after the marathon, then what? You’ll look back on it as a great achievement, but what will it do for your future health?
PS, yes, marathon-running in one’s middle age is a fine and good activity for most people. Maybe skip it if you have osteoporosis or some other relevant problem (check with your doctor), but…
Marathons in Mid- and Later-Life ← we wrote about the science of it here
PS, we also explored some science that may be applicable to your other question, on the same page as that about marathons!
The thing about habits vs goals is that habits give ongoing cumulative (often even: compounding) benefits:
How To Really Pick Up (And Keep!) Those Habits
If you pressingly want advice on goals though, our advice is this:
Make it your goal to be prepared for the health challenges of later life. It may seem gloomy to say that old age is coming for us all if something else doesn’t get us first, but the fact is, old age does not have to come with age-related decline, and the very least, we can increase our healthspan (so we’re hitting 90 with most of the good health we enjoyed in our 70s, for example, or hitting 80 with most of the good health we enjoyed in our 60s).
If that goal seems a little wishy-washy, here are some very specific and practical ideas to get you started:
Train For The Event Of Your Life!
As for the limits and/or extents of how much we can do in that regard? Here are what two aging experts have to say:
And here’s what we at 10almonds had to say:
Age & Aging: What Can (And Can’t) We Do About It?
Take care!
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