Pregnancy in Women With Physical Disabilities

Abstract

The Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored a 2-day workshop to assess the body of evidence on pregnancy in women with physical disabilities, identify gaps in knowledge, and formulate recommendations for further research. A multidisciplinary group of experts discussed available data on pregnancy outcomes among women with varying physically disabling conditions, medical and psychosocial risks for mothers and children, and barriers to prenatal care and parenting for women with physical disabilities. Existing evidence is limited by a preponderance of retrospective single-site studies of small sample sizes. For most women, pregnancy outcomes are favorable. However, increased rates of certain adverse outcomes, such as low birth weight (related to preterm birth or growth restriction) and cesarean delivery, have been reported in women with spinal cord injuries, rheumatoid arthritis, multiple sclerosis, or other conditions. Common morbidities across conditions may include urinary tract infections, decreased mobility and independence, skin ulceration, respiratory compromise, interpersonal abuse, stress, and mood disorders. Socioeconomic, physical, and attitudinal barriers to antenatal care and independent parenting can be problematic. Current evidence, although limited, indicates that most women with physical disabilities will have good pregnancy outcomes; however, some data suggest that rates of a range of complications may be more common among women with physical disabilities, depending on the nature and severity of the underlying condition. Many questions remain unanswered. Establishment of a systematic and comprehensive registry of pregnancy course and outcomes among women with physical disabilities is of high priority for addressing persistent gaps in knowledge.

The influence of visual impairment on pregnancy outcomes

“…There are few studies that have shown that most disabled women will have good pregnancy outcomes; however, some data indicates that complications may be more prevalent among women with physical disabilities, according to the nature and severity of the underlying condition. Some researchers have shown that pregnant women with physical disabilities had higher rates of preterm deliveries, low birth weight infants, and pregnancy complications [18]. In those studies, visual impairment was not investigated as a chronic physical disability, but according to the Israel Ministry of Social Affairs it is considered a physical disability that needs special day-by-day instruments for orientation, mobility, reading, and adjusted access to facilities within the community.…”

Paraplégie et grossesse : à propos d’une série rétrospective continue sur 11 années au CHU de Toulouse

“…Le meilleur moyen de vider la vessie tout en minimisant le risque infectieux est de pratiquer des autosondages à raison d'au moins cinq fois par 24 heures (faire en sorte que le volume ne dépasse pas 400 mL d'urines par sondage). Il est par ailleurs conseillé d'augmenter les apports hydriques de manière à obtenir une diurèse quotidienne d'au moins 1,5 L [6,7].…”

“…Il apparaît par ailleurs nécessaire d'insister sur la prévention du risque thromboembolique (port de bas de contention, kinésithérapie, héparinothérapie en cas d'alitement) [7]. Une patiente de notre série, sans traitement prophylactique, a présenté une thrombose veineuse profonde proximale.…”

“…Il est également recommandé une prévention de la constipation en privilégiant les mesures hygiéno-diététiques [2]. Au total, le taux de patientes hospitalisées en cours de grossesse est important (58,8 %) [6,7,12].…”

Headache and Neurological Disease in Pregnancy

“…32 It is thought to be a result of uncertain in utero events or brain damage from injury or infection in childhood. 33 Currently there are 400,000 adults living with CP in the United States, with 10,000 new cases occurring per year.…”