Pregnancy among US women: differences by presence, type, and complexity of disability

Horner‐Johnson, Willi; Darney, Blair G.; Kulkarni-Rajasekhara, Sheetal; Quigley, Brian; Caughey, Aaron B.

doi:10.1016/j.ajog.2015.10.929

Cited by 72 publications

(48 citation statements)

References 23 publications

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“…This likely underestimates the proportion of births to women with disabilities because our data included only diagnoses coded at delivery. Previous research has reported that 12% of women of reproductive age have disabilities (Brault, et al, 2009) and 11% of reproductive age women with disabilities have been pregnant (Horner-Johnson, et al, 2016). However, our population represents a different and broader denominator: all women who gave birth in California 2000–2010.…”

Section: Discussionmentioning

confidence: 99%

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Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities

Darney

Biel

Quigley

et al. 2017

Women's Health Issues

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INTRODUCTION Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. OBJECTIVE To determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. METHODS We conducted a retrospective cohort study of all deliveries in California 2000–2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using ICD-9 codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for socio-demographic characteristics and co-morbidities and stratified by parity. RESULTS In our sample, 0.45% (20,894/4,610,955) of deliveries were to women with disabilities. A larger proportion of women with disabilities were nulliparous, had public insurance, and had co-morbidities (e.g., gestational diabetes) compared with women without disabilities (p<0.001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% versus 16.3%, p<0.001; aOR = 2.05; 95% CI = 1.94–2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% versus 16.3%, p<0.001; aOR = 6.83; 95%CI = 5.46–8.53). CONCLUSION Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Recent research indicates that pregnancy is as common among women with disabilities as among women without disabilities (Horner-Johnson, Darney, Kulkarni-Rajasekhara, Quigley, & Caughey, 2016). However, utilization of prenatal care is lower among women with disabilities (Gavin, Benedict, & Adams, 2006).…”

Section: Introductionmentioning

confidence: 99%

Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities

Darney

Biel

Quigley

et al. 2017

Women's Health Issues

Self Cite

View full text Add to dashboard Cite

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“…Prior research with smaller samples suggests that important factors may include transportation barriers; limited insurance coverage; inaccessible programs, health care facilities, and/or equipment; stereotypes, discrimination, and/or providers who lack training or sensitivity and/or fail to recognize women with disabilities as reproductive and sexual beings. 4, 12, 15-17 …”

Section: Discussionmentioning

confidence: 99%

“…2, 3, 11-14 They may encounter inaccessible health care facilities and equipment, stereotypes and discrimination, inaccessible family planning clinics, programmatic inaccessibility, transportation barriers to accessing facilities, limited coverage of health care, and providers who lack disability-related training or sensitivity and/or fail to recognize the woman as a person with sexual and reproductive health care needs. 4, 12, 15-17 Moreover, they may experience problematic interactions between hormonal methods of contraception and disability-related medications; difficulties using barrier methods due to limitations in manual dexterity, loss of sensation, contractures, or spasticity. 5, 18 …”

Section: Introductionmentioning

confidence: 99%

“…3 In the past five years, however, there have been several groundbreaking studies using population-based data to investigate pregnancy and its outcomes in women with disabilities. 2, 12-14 Further research using population-based data is needed to understand the impact of functional limitations and other disability-related factors on the use of contraceptive methods and access to family planning services in this substantial and underserved population.…”

Section: Introductionmentioning

confidence: 99%

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Disparities in receipt of family planning services by disability status: New estimates from the National Survey of Family Growth

Mosher

Bloom

Hughes

et al. 2017

Disability and Health Journal

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Background A substantial and increasing population of US women of childbearing age live with disability. Disability-based disparities in access to family planning services have been previously documented, but few studies have used population-based data sources or evidence-based measures of disability. Objective To determine population-based estimates of use of family planning services among women 15 – 44 years of age in the United States, and to examine differences by disability status. Methods This is a secondary analysis of a cross-sectional survey, the 2011-2015 National Survey of Family Growth. These analyses include 11,300 female respondents between the ages of 15 and 44 who completed in-person interviews in respondents' homes. Results Approximately 17.8% of respondents reported at least one disability in at least one domain. Women with disabilities were less likely than those without disabilities to receive services; the largest differences by disability status were seen among women with low education, low income, and those who were not working. Logistic regression analysis suggests that women with physical disabilities and those with poorer general health are less likely to receive services. Conclusions Women living with disabilities reported lower receipt of family planning services compared to women without disabilities, but the differences were small in some subgroups and larger among disadvantaged women. Physical disabilities and poor health may be among the factors underlying these patterns. Further research is needed on other factors that affect the ability of women with disabilities to obtain the services they need to prevent unintended pregnancy.

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Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities

et al. 2021

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IMPORTANCEWomen with disabilities have a higher risk of preterm birth, gestational diabetes, preeclampsia, and cesarean delivery; however, their risk of other obstetric interventions, adverse maternal outcomes, and clinical indications for increased cesarean delivery is unclear. OBJECTIVE To evaluate risk of a range of obstetric interventions and adverse maternal outcomes, including severe maternal morbidities (SMM) and mortality, among women with and without disabilities. DESIGN, SETTING, AND PARTICIPANTS The Consortium on Safe Labor was a retrospective cohort that included comprehensive medical chart review for deliveries between January 2002 and January 2008. Data were collected from 12 clinical sites, which included 19 hospitals across the United States. This secondary analysis was conducted in February to July 2021. EXPOSURES Using International Classification of Diseases, Ninth Revision, codes and a validated algorithm to define disability, participants were classified as having physical, intellectual, sensory, or any disability, and compared with women with no documented disability. MAIN OUTCOMES AND MEASURES The relative risk (RR) of 23 obstetric interventions and adverse maternal outcomes, including SMM and mortality, was evaluated. RESULTSOf the 223 385 women in the study, 9206 (4.1%) were Asian or Pacific Islander, 50 235 (22.5%) were Black, 39 039 (17.5%) were Hispanic, and 110 443 (49.4%) were White, with a mean (SD) age of 27.6 (6.2) years. There were 2074 (0.9%) women with disability and 221 311 (99.1%) without. Among women with disabilities, 1733 (83.5%) were physical, 91 (4.4%) were intellectual, and 250 (12.1%) were sensory. Compared with women with no disability, women with disabilities had higher risk of gestational diabetes, placenta previa, premature rupture of membranes, preterm premature rupture of membranes, and postpartum fever as well as maternal death (adjusted relative

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Pregnancy among US women: differences by presence, type, and complexity of disability

Cited by 72 publications

References 23 publications

Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities

Primary Cesarean Delivery Patterns among Women with Physical, Sensory, or Intellectual Disabilities

Disparities in receipt of family planning services by disability status: New estimates from the National Survey of Family Growth

Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities

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