Maternal and offspring outcomes in women with intellectual and developmental disabilities: a population‐based cohort study

Abstract

Objective To compare the risks for adverse maternal and offspring outcomes in women with and without intellectual and developmental disabilities.Design Population-based cohort study.Setting Ontario, Canada.Population Singleton obstetrical deliveries to 18-to 49-year-old women with and without intellectual and developmental disabilities (n = 3932 in the exposed cohort, n = 382 774 in the unexposed cohort; 2002-2011 fiscal years).Methods Women with intellectual and developmental disabilities were identified based on diagnoses in health administrative data or receipt of disability income support. The unexposed cohort comprised women without intellectual and developmental disabilities. Modified Poisson regression was used to compute adjusted relative risks (aRR) and 95% confidence intervals (CI) comparing the two cohorts.Main outcome measures Primary maternal outcomes were: gestational diabetes, gestational hypertension, pre-eclampsia, eclampsia, and venous thromboembolism. Primary offspring outcomes were: preterm birth, small for gestational age, and large for gestational age.Results The exposed cohort, compared with the unexposed cohort, had increased risks for pre-eclampsia (aRR 1.47, 95% CI 1.11-1.93) and venous thromboembolism (aRR 1.60, 95% CI 1.17-2.19). Their offspring had increased risks for preterm birth (aRR 1.63, 95% CI 1.47-1.80) and small for gestational age (aRR 1.35, 95% CI 1.25-1.45).Conclusions These findings suggest that there is a need to address modifiable risk factors for adverse outcomes among women with intellectual and developmental disabilities prior to and during pregnancy. Moreover, there is a need to enhance monitoring for maternal and offspring complications in this population.Keywords Developmental disabilities, intellectual disability, preeclampsia, preterm birth, small for gestational age, venous thromboembolism.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

“…Twenty-three studies, representing 8,514,356 women in 19 distinct cohorts (including 1 US study that examined 4 states separately), 50 met our inclusion criteria and were included in the qualitative synthesis. Three articles from Canada [44][45][46] and 9 from the United States representing 3 different investigations (2 using California administrative data, 49,53 5 using the Pregnancy to Early Life Longitudinal Data System, 47,48,56,58,59 and 2 using the Pregnancy Risk Assessment Monitoring System for Rhode Island 57,61 ) used the same data sources and had fully or partially overlapping samples and study periods. Table 3 describes the studies' characteristics.…”

“…Studies examined the impact of maternal disability overall (n ¼ 10) 47e50, 53,54,57,61,64,66 or physical (n ¼ 1), 60 sensory (n ¼ 2), 62,65 or intellectual and developmental disabilities separately (n ¼ 10). [44][45][46]51,52,55,56,58,59,63 Of the studies that examined the impact of maternal disability overall, 4 compared an any-disability group with a nodisability referent group, 50,57,61,66 and 6 also reported findings broken down by disability type. 47e49, 53,54,64 Six studies included women with mental health disorders within their any-disability group.…”

Health care utilisation in infants and young children born to women with intellectual and developmental disabilities: A systematic review and meta‐analysis

“…Our finding of increased risk for NICU/SCN admission among infants of women with IDD may be explained by pre-existing maternal conditions (Ozkaya et al 2010;Collings and Llewellyn 2012), poor maternal access to prenatal care (Redshaw et al 2013) and higher rates of pregnancy and delivery complications among women with IDD (Brown et al 2016a) which may result in adverse neonatal outcomes such as preterm birth, small-forgestational-age (Akobirshoev et al 2017;Brown et al 2017) and neonatal morbidity (Höglund et al 2012a(Höglund et al , 2012bParish et al 2015;Mitra et al 2015b) and therefore higher rates of NICU/SCN admission. Small sample sizes may explain the non-statistically significant differences in immunisation rates and hospitalisations of children of mothers with and without IDD.…”

“…Childbearing rates among women with intellectual and developmental disabilities (IDD) have increased over the past three decades (McConnell et al 2008;Hindmarsh et al 2015;Brown et al 2017). IDD describes disabilities affecting intellectual functioning (e.g.…”

“…Examples include autism, Down syndrome and Fragile X syndrome. Mothers with IDD face significant social, health and mental health disparities (Brown et al 2017). Their schoolaged children are at risk for poor socio-emotional well-being and behaviour problems (Hindmarsh et al 2017).…”