Perinatal Health of Women with Intellectual and Developmental Disabilities and Comorbid Mental Illness

Abstract

Objective: Women with intellectual and developmental disabilities (IDD) have high rates of adverse perinatal outcomes. However, the perinatal health of women with co-occurring IDD and mental illness (dual diagnosis) is largely unknown. Our objectives were to 1) describe a cohort of women with dual diagnosis in terms of their social and health characteristics and 2) compare their risks for adverse maternal and neonatal outcomes to those of women with IDD only. Method: We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton obstetric deliveries to women with dual diagnosis (n ¼ 2080) and women with IDD only (n ¼ 1852; 2002-2012). Primary maternal outcomes were gestational diabetes, gestational hypertension, preeclampsia/eclampsia, and venous thromboembolism. Primary neonatal outcomes were preterm birth, small for gestational age, and large for gestational age. We also examined several secondary outcomes. Results: Women with dual diagnosis were more likely than women with IDD only to live in poor neighborhoods and to have prepregnancy health conditions; however, they had more frequent prenatal care. Infants born to women with dual diagnosis had increased risks for preterm birth (adjusted relative risk [aRR] 1.31, 95% confidence interval [CI] 1.08 to 1.59) and neonatal morbidity (aRR 1.35, 95% CI 1.03 to 1.76) compared with infants born to women with IDD only. All other primary and secondary outcomes were nonsignificant. Conclusions: Comorbid mental illness contributes little additional risk for adverse perinatal outcomes among women with IDD. Women with dual diagnosis and women with IDD alone require increased surveillance for maternal and neonatal complications. Abré gé Objectif : Les femmes souffrant de déficiences intellectuelles et développementales (DID) ont des taux élevés de résultats périnataux indésirables. Cependant, la santé périnatale des femmes souffrant de DID et de maladie mentale (diagnostic mixte) co-occurrentes est largement inconnue. Nos objectifs étaient de : (1) décrire une cohorte de femmes ayant un diagnostic mixte en ce qui concerne leurs caractéristiques de santé et sociales, et (2) comparer leurs risques de résultats maternels et néonataux indésirables avec ceux des femmes souffrant uniquement de DID.

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

“…Our results were also in line with Darney et al’s [ 28 ] work in a retrospective cohort of all live births in California from 2000–2010 (gestational diabetes: 8.1%; caesarean delivery: 38.0%). In the Ontario health system from 2002–2010, Brown et al [ 29 ] found lower rates of gestational diabetes (3.2%) and gestational hypertension (1.2%) compared to our findings with similar rates of caesarean delivery (27.0%). With these consistent results, obstetricians should be aware of the high risk of maternal morbidity when treating pregnant women with IDD and researchers need to continue to investigate mechanistic pathways and IDD-specific interventions and preventive programs.…”

Immigrant women and women with learning disabilities have complex mental health needs and service use in the perinatal period

“…There is clear evidence-based guidance on the detection and treatment of perinatal mental disorders in the general population,5 6 but little evidence on vulnerable subgroups who may have distinct clinical presentation and/or service needs. In the two selected studies, population-based regional Canadian data are used to investigate perinatal mental health among migrant women (focusing on their postnatal use of mental health services compared with non-migrant women),7 and among women with intellectual or developmental disabilities (IDD) (focusing on adverse maternal and neonatal outcomes among women with comorbid IDD and mental illness compared with women with IDD only) 8…”

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

“…The physical, social and psychological demands of caring for a newborn can increase vulnerability to many health problems, including depression and anxiety. Moreover, mothers’ health and well-being during postpartum may exert lasting effects on themselves and their newborns 14. It is reasonable to suspect that the rates of postpartum psychiatric emergencies among women with IDD reported here are an underestimate.…”