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The U.S. Department of Defense (DoD) is tasked with protecting and promoting the health of Service members and their families. Concerns exist that the unique occupational exposures inherent in military service may pose reproductive health risks. Additionally, the increasing number of women serving in the military underscores the need to identify any potential risks. Recognizing this, the Assistant Secretary of Defense for Health Affairs directed the establishment of a birth defects surveillance program for military families in 1998. As a result, the DoD Birth and Infant Health Research (BIHR) program was established and is led by the Naval Health Research Center.

Initially developed to monitor birth defects, the mission of the BIHR program has expanded to conduct regular surveillance of births to military members and their spouses and ongoing research of maternal, pregnancy, and infant health outcomes (including birth defects) to understand how military service affects reproductive health.

The research team also manages the National Smallpox Vaccine in Pregnancy Registry (NSVIPR) which actively enrolls women who are inadvertently vaccinated with smallpox/mpox vaccine during, or just prior to, pregnancy. Once enrolled, these women are surveyed periodically, until there is an outcome (loss or live birth). Infants of mothers exposed to smallpox/mpox vaccine are followed to monitor their health outcomes into early school age.


  • The research conducted by the BIHR team supports the health of military families by assessing potential risks related to reproductive health outcomes. Findings are shared with military leadership and the scientific community to help direct future policies related to reproductive health.


  • Increase understanding of the reproductive health effects of military service
  • Examine birth defect rates in military families and investigate those rates based on specific exposures
  • Study other infant outcomes such as preterm birth, low birth weight, and sex ratio
  • Study pregnancy outcomes such as loss, preterm labor, and preeclampsia
  • Study maternal outcomes such as severe maternal morbidity, maternal mortality, and failure of long-acting reversible contraceptives
  • Assess how various factors such as parental leave policy and racial disparities in healthcare may impact maternal, pregnancy, and infant outcomes


The team’s researchers have direct access to large databases, allowing for thorough capture of:
  • Pregnancy and maternal outcomes among military members and their spouses
  • All birth and health outcomes for infants born to military families up to their first birthday, or beyond for those with continuous care in the system through early school ages

Core Data Sources:

  • Military Health System (MHS) Data Repository (MDR)
  • Defense Enrollment Eligibility Reporting System (DEERS)
  • Defense Manpower Data Center (DMDC)

Study Population:

  • MHS beneficiaries, including service members and their families

Health Outcomes:

  • Maternal and pregnancy (such as pregnancy loss, pre-eclampsia, preterm labor, gestational diabetes, severe maternal morbidity)
  • Infant (such as birth defects, preterm birth, birth weight, growth problems in utero or in infancy)
Potential Risk Factors:
  • Parent demographics (such as sponsor and maternal age, sponsor race and ethnicity)
  • Military-unique (such as deployment, geographical location, occupation)
  • Vaccinations (complete vaccination records for military members, as many are mandatory, provide the capability to assess risks/benefits related to vaccinations received in pregnancy)



  • Approximately 100,000 infants are born to military families annually and are included in the program’s surveillance and research
  • Nearly 2.8 million infants, born 1998-2022, are currently included in the database
  • Birth defect rates are similar for military women and dependent spouses, and are consistent with rates among civilians
  • Rates of maternal adverse outcomes (such as pregnancy loss) among active duty women are comparable to or lower than rates among the general U.S. population
  • Questions? Please contact the research team at with any questions.



Initiated in 2003, the NSVIPR actively enrolls women who have received the ACAM2000 smallpox vaccine or the JYNNEOS smallpox/mpox vaccine during pregnancy. For more information about the NSVIPR, click on the link below:

To refer a patient to the NSVIPR, please complete and return this National Smallpox Vaccine in Pregnancy Referral Form

Please contact the vaccine in pregnancy research team at with any questions.

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