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

Abstract

O ne in 10 women of reproductive age has a disability. 1 While disabilities vary in their etiology and impact, they can be classified broadly based on common activity limitations. 2,3 Physical disabilities, such as cerebral palsy and spinal cord injuries, are those associated with limits to mobility, flexibility, and dexterity; sensory disabilities include vision and hearing impairments; and intellectual and developmental disabilities, such as Down syndrome, autism spectrum disorder, and fetal alcohol spectrum disorder, are associated with limitations in cognitive and adaptive functioning. In the past, stigma associated with disability and sexuality and medical factors, including risks of medication use in pregnancy, limited childbearing in women with disabilities. 4,5 However, with greater recognition of the reproductive rights of persons with disabilities 6 and medical advances, more women with disabilities now experience pregnancy. In fact, the 2008e2012 US Medical Expenditure Panel Survey showed that similar proportions of

Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid

“…When comparing women with IDD to a non-IDD sample, our estimates align with the recent meta-analysis by Tarasoff et al [ 11 ] For gestational diabetes, our uRR of 1.28 was larger than the meta-analytic unadjusted pooled odds ratio of 1.10 (assuming odds ratio approaches RR) yet was within the range of other studies (odds ratio range: 0.77–1.71). Our uRR for gestational hypertension (1.22) was smaller than the meta-analytic estimate (odds ratio 1.77) but within previous studies’ range (0.63–2.49).…”

“…Our uRR for gestational hypertension (1.22) was smaller than the meta-analytic estimate (odds ratio 1.77) but within previous studies’ range (0.63–2.49). Lastly, Tarasoff et al [ 11 ] estimated unadjusted and adjusted odds ratios for caesarean delivery finding an unadjusted and adjusted pooled odds ratio of 1.29 and 1.46 respectively. The pooled odds ratio for caesarean delivery (1.46) was higher than our estimate (aRR 1.29), possibly due to the odds ratio overestimating the risk ratio given the high prevalence of caesarean delivery.…”

“…A recent meta-analysis identified 10 studies of pregnancy outcomes for women with IDD suggesting that women with IDD are more likely than peers to experience complications [ 11 ]. Yet, studies of pregnancy in women with IDD are often confounded by socioeconomic status because a full population comparison groups does not mirror the lower socioeconomic profile of the IDD population [ 11 ].…”

“…A recent meta-analysis identified 10 studies of pregnancy outcomes for women with IDD suggesting that women with IDD are more likely than peers to experience complications [ 11 ]. Yet, studies of pregnancy in women with IDD are often confounded by socioeconomic status because a full population comparison groups does not mirror the lower socioeconomic profile of the IDD population [ 11 ]. Medicaid, a federal-state partnership to provide low- or no-cost health care, nursing home care, and personal care services to low-income individuals in the US, is a source of data that may allow for assessment of more like IDD and non-IDD groups.…”

Current Resources for Evidence‐Based Practice, November/December 2019

“…Tarasoff and colleagues’ meta‐analysis of pregnancy outcomes from 16 separate cohorts among over 8 million women, of whom over 62,000 had physical disability, sensory disability, or intellectual or developmental disability (IDD), will be helpful to midwives who find themselves caring for this population of women . The size of cohort varied from one with as few as 23 women with disability to very large population studies with over 25,000 affected women.…”