Experiences of Pregnancy Care Coordination in the VA Health Care System Among Women Veterans With Rheumatoid Arthritis: A Qualitative Exploration of Barriers and Facilitators

Abstract Introduction Women Veterans (WVs) with rheumatoid arthritis (RA) experience increased risks during pregnancy and often require coordinated, multi-disciplinary care across Veterans Affairs (VA) and community health systems. Although the VA provides maternity care coordinators (MCCs), little is known about how WVs with RA and their providers perceive pregnancy-related care and communication within and outside the VA. This study identified barriers and facilitators to coordinated pregnancy and postpartum care for WVs with RA. Materials and Methods We conducted semi-structured virtual interviews with WVs with RA (n = 9) and VA health care providers involved in reproductive and rheumatologic care, including rheumatologists (n = 5), primary care provider (PCPs) (n = 4), and MCCs (n = 4). Interview guides were informed by the Cumulative Complexity Model and Chronic Care Model. Using Hamilton’s rapid qualitative analysis approach, we summarized transcripts into a structured matrix, compared themes across participant groups, and generated system-level insights regarding reproductive care coordination. Results Veterans reported limited awareness of RA-specific pregnancy and postpartum resources. They relied on OB/GYNs, rheumatologists, MCCs, and online communities for disease-specific guidance, particularly regarding medication safety and symptom management. Although OB/GYN and PCP care were generally perceived as supportive, rheumatology engagement during pregnancy varied widely because of lack of communication pathways, unclear provider roles, and variable provider comfort with pregnancy care. Veterans frequently served as intermediaries between their VA and non-VA providers. Providers across roles reported minimal formal training in reproductive rheumatology and limited access to reproductive rheumatology expertise within the VA. Rheumatologists and PCPs depended heavily on MCCs and community obstetric teams for pregnancy-related decision-making. MCCs described structured trimester-based workflows and emphasized their role in referral management and care navigation but noted challenges including delays in community subspecialty access and lack of resources tailored to chronic conditions like RA. Across participants, limited direct communication between VA and community obstetric teams was a key barrier to care coordination. Conclusions Pregnant WVs with RA experience fragmented care across systems despite strong MCC support. Opportunities exist to improve outcomes through disease-specific educational resources, enhanced provider training in reproductive rheumatology, and standardized workflows that facilitate early and ongoing communication between VA subspecialists and community obstetric teams. These findings may also inform care models for other chronic conditions requiring multidisciplinary pregnancy management.