Incidence of Postpartum Depression Decreases After Initial Expansion of Military Maternity Leave.

INTRODUCTION: Postpartum depression impacts 1 in 8 women in the United States. Research has indicated maternity leave duration, and compensation can have an impact on postpartum depression symptoms. The U.S. military increased their maternity leave provision from 6 to 12 weeks in 2016. The aim of this study was to expand upon current literature on the role of maternity leave on postpartum depression by analyzing objective data from 2011 to 2019 utilizing military health records. METHODS: All deliveries to active duty women in the Military Health System from 2011 to 2019 were considered for analysis. A total of 60,746 women met inclusion criteria. Active duty women were stratified by year of delivery to identify if they had 6 weeks (2011-2015) or 12 weeks (2016-2019) of maternity leave. International Classification of Disease (ICD)-9 and ICD-10 codes were used for the identification of postpartum depression diagnosis. Logistic regression models were used to assess the association between maternity leave provision and postpartum depression diagnosis adjusting for covariates. RESULTS: Overall, 4.8% of the women were diagnosed with postpartum depression. Active duty women who were allotted 12 weeks (2016-2019) of maternity leave had higher odds of postpartum depression diagnosis than those allotted 6 weeks (2011-2015) (12 weeks vs. 6 weeks of leave: odds ratio [OR] = 1.29; 95% confidence interval [CI] = 1.20-1.39, P < 0.0001). However, there was a 50% reduction in odds of postpartum depression during 2016-2017 (the 2 years following the 12-week leave implementation) in comparison to 2011-2015 (OR = 0.50; 95% CI = 0.43-0.57, P < 0.0001). The trends were similar across military branches. Additionally, between 2011 and 2019, the lowest rates of postpartum depression were observed during 2016-2017, but the rates significantly increased starting 2018. Overall, women with lower military ranks had higher postpartum depression rates than those with higher ranks. CONCLUSIONS: Our results indicate increasing paid maternity leave in the military from 6 to 12 weeks did initially lower the odds of postpartum depression diagnosis among active duty women from immediately after policy implementation (2016) and prior to the release of the Veterans Affairs and Department of Defense Clinical Practice Guidelines on Pregnancy Management (2018). Later, increased odds of depression (2018-2019) are likely due to increased depression screening protocols at the Military Treatment Facilities in the perinatal period.

Extending Air Force Physical Fitness Postpartum Dwell Time Improves Maternal Physical Readiness.

INTRODUCTION: Research suggests women are more likely to fail their military physical fitness assessment in the immediate postpartum period than in the prenatal period. In 2015, the United States Air Force physical fitness postpartum testing dwell time increased from 6 months to 12 months postpartum. The primary aim of this study was to assess if Air Force active duty women's physical readiness, as indicated by individual physical fitness test results, was impacted by this change. The secondary aim was to determine the postpartum duration for active duty Air Force women to return to their prenatal anthropometric measurements. METHODS: All active duty Air Force women who gave birth from 2011-2019 in the military medical system were considered for analysis. A total of 6,726 women meeting inclusion criteria were grouped to 6 month testers (delivery between 2011-February 2015) and 12 month testers (delivery between March 2015 and 2019). Logistic regression and general linear models were used to assess the associations and predictability of the various fitness and anthropometric components of the physical fitness testing requirements (6 vs. 12 month testers), controlling for covariates (age, military rank, marital status, and ethnicity). RESULTS: Those testing at 12 months had decreased odds (odds ratio = 0.40, 95% CI = 0.32-0.49, P < .0001) of failing their initial postpartum fitness test than those testing at 6 months. The prevalence of test failure at the first exam postpartum was 10.4% among 6 month testers and 4% among 12 month testers. Women who tested at 6 months retained relatively more weight (2.7 ± 5.0 kg, 4.2% increase), body mass index (1.0 ± 2.1 kg/m2, 4.5% increase), and abdominal circumference (2.4 ± 4.9 cm, 3.5% increase) than their counterparts testing at 12 months (1.8 ± 5.4 kg, 2.8% increase; 0.7 ± 2.2 kg/m2, 3.0% increase; and 1.8 ± 5.0 cm, 2.7% increase; respectively) (P < .0001). When comparing those with prenatal fitness status of "excellent," "pass," or "fail," no group attained prenatal weight status in the 24 months monitored. Average weight and abdominal circumference retention for all groups at 24 months postpartum were 2.8 kg and 1.3 cm, respectively. Among initial postpartum fitness testing failures, the component most failed was sit-ups (34.5%), followed by the 1.5-mile run (29.8%). Six month testers were more likely, across all prenatal fitness categories ("fail," "pass" and "excellent") to fail postpartum fitness testing compared to 12 month testers (26.1%, 17.7%, and 5.6% vs.19.4%, 7.3% and 2%, respectively). CONCLUSIONS: The decision of the Air Force to increase the minimal required time between childbirth and postpartum physical fitness testing for women has positively impacted fitness test failure rates and anthropometric measure changes. Additional policy should be implemented to support postpartum holistic health interventions.

Increasing Maternity Leave and Decreasing Attrition Rates of U.S. Active Duty Women in the Prenatal and Immediate Postpartum Period.

INTRODUCTION: The USA currently does not have a national parental leave policy. In 2016, the Secretary of Defense increased the allotted maternity leave for active duty U.S. military members from 6 to 12 weeks. The purpose of this study was to understand the potential impact of this change on attrition rates of active duty women in the Army, Air Force, Navy, and Marines from their initial prenatal visit through the first year postpartum. METHODS: All active duty women who had a confirmed pregnancy in the electronic health record from 2011 to 2019 were included for consideration in the study. A total of 67,281 women met the inclusion criteria. These women were followed from their initial documented prenatal visit for 21 months (9 months gestation and 12 months postpartum) for removal from the Defense Eligibility and Enrollment Reporting System signaling attrition from service presumably related to pregnancy or childbirth. Logistic regression models were used to assess the association between maternity leave policy and attrition adjusting for covariates. RESULTS: Overall, women who were allotted 6 weeks of maternity leave were associated with higher attrition relative to women provided 12 weeks of maternity leave (odds ratio = 1.36; 95% CI, 1.31-1.42; P < .0001), representing a 22% decrease in attrition rates of women given 12 weeks vs. 6 weeks of leave. This impact of attrition rate was the greatest among members who were of lower rank (6 weeks vs. 12 weeks of leave: junior enlisted (E1-E3), 29.2% vs. 22.0%, P < .0001 and non-commissioned officer (E4-E6), 24.3% vs. 19.4%, P < .0001) and who served in the Army (28.0% vs. 21.2%, P < .0001) and Navy (20.0% and 14.9%, P < .0001). CONCLUSIONS: Family-friendly health policy appears to have the intended outcome of retaining talent in the military workforce. The impact of health policy on this population can provide a glimpse into the influence of similar policies should they be implemented nationwide.

Sneakers and spokes: an assessment of the walkability and bikeability of U.S. postsecondary institutions.

The purpose of the study described in this article was to assess the walkability and bikeability of 15 U.S. postsecondary education campuses. The Centers for Disease Control and Prevention's evidence-based Healthier Worksite Initiative Walkability Audit was modified to rate campus walking and biking path segments for path safety, quality, and comfort. Universities (n = 13) assessed an average of 44 path segments, which earned a mean score of 72.71 +/- 10.77 SD (possible range 0 to 100). Postsecondary technical schools (n = 2) assessed 20 path segments, which received an average score of 76.56 +/- 13.15. About 70% of path segments received a grade A or B, but almost 1 in 10 received a failing or poor support score for walking and biking. Nearly half or more campus environments scored significantly below an acceptable score on many path safety and quality criteria. Postsecondary education campuses that are supportive of walking and biking offer numerous benefits to the environment and people. Findings from environmental assessments like the data reported here can provide valuable input to campus planners.