Prenatal Care Adequacy Among Women With Disabilities: A Population-Based Study

Nishat, Fareha; Lunsky, Yona; Tarasoff, Lesley A.; Brown, Hilary K.

doi:10.1016/j.amepre.2021.05.037

Cited by 16 publications

(13 citation statements)

References 43 publications

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“…ED use is a barometer of not only acute illness but also chronic illness and access to outpatient care. Our data suggest the need for research assessing the effectiveness of multifaceted strategies to prevent ED visits in pregnant people with disabilities and prepare them for when ED visits occur . For example, proactive preconception care and interdisciplinary prenatal care approaches could be beneficial to manage disability-related concerns and comorbidities in disabled people and reduce their risks of urgent ED visits due to exacerbated underlying conditions and obstetrical complications .…”

Section: Discussionmentioning

confidence: 96%

“…However, ED visits in pregnancy in people with disabilities may also reflect shortcomings in outpatient care. Although we could only measure the timing and number of prenatal visits, qualitative research shows people with disabilities are less likely to receive high-quality prenatal care, with such settings being physically inaccessible, lacking resources to address communication needs, and offering insufficient appointment times to address disability and pregnancy-related concerns . Clinicians may also have negative attitudes toward pregnant disabled people and insufficient knowledge of their health and social needs .…”

Section: Discussionmentioning

confidence: 99%

“…Our data suggest the need for research assessing the effectiveness of multifaceted strategies to prevent ED visits in pregnant people with disabilities and prepare them for when ED visits occur. 36 For example, proactive preconception care and interdisciplinary prenatal care approaches could be beneficial to manage disability-related concerns and comorbidities in disabled people and reduce their risks of urgent ED visits due to exacerbated underlying conditions and obstetrical complications. 10,11 There may also be a need for efforts to improve the capacity of outpatient services to provide accessible prenatal care, thus reducing risks of nonurgent ED visits.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

et al. 2023

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ImportanceEmergency department (ED) use in pregnancy is common and occurs for a variety of reasons, including obstetrical complications, exacerbated underlying conditions, and inadequate outpatient health care access. People with disabilities have elevated rates of certain medical, psychiatric, and obstetrical conditions as well as inadequate access to prenatal care; their risk of ED use in pregnancy is not known, however.ObjectiveTo compare the risk of ED use in pregnancy among people with physical, sensory, and intellectual or developmental disabilities with those without disabilities.Design, Setting, and ParticipantsPopulation-based cohort study leveraging linked administrative health data sets in Ontario, Canada, April 2003 to March 2019. Analysis included all recognized pregnancies to people with a preexisting physical, sensory, intellectual or developmental, or 2 or more (multiple) disabilities, and those without a disability. Data were analyzed from May 2022 to January 2023.ExposureDisability was ascertained using algorithms applied to 2 or more outpatient physician visits or 1 or more ED visits or hospitalizations before conception.Main outcomes and measuresModified Poisson regression–generated adjusted relative risks (aRR) and 95% CIs for any ED visit in pregnancy, from the estimated conception date up to the end of the pregnancy, adjusted for age, parity, income quintile, rurality, immigrant status, and preexisting chronic conditions, mental illness, and substance use disorders.ResultsThe cohort included 2 659 895 pregnant people with physical (221 739 participants; mean [SD] age, 29.8 [6.1] years), sensory (71 891 participants; mean [SD] age, 29.1 [6.4] years), intellectual or developmental (3877 participants; mean [SD] age, 26.1 [6.7] years), and multiple disabilities (14 359 participants; mean [SD] age, 29.5 [6.5] years), and pregnant people without a disability (2 348 023 participants; mean [SD] age, 29.4 [5.9] years). The rate of ED visits in pregnancy was 25.4% in people without a disability (596 771 visits). Relative to these individuals, the aRR for ED use was elevated in people with physical (aRR, 1.26; 95% CI, 1.25-1.27), sensory (aRR, 1.15; 95% CI, 1.14-1.17), intellectual or developmental (aRR, 1.33; 95% CI, 1.28-1.38), and multiple disabilities (aRR, 1.43; 95% CI, 1.40-1.46).Conclusions and RelevanceIn this population-based study, people with disabilities were at elevated risk of ED use in pregnancy. This finding underscores the need for research on the benefits of proactive strategies to manage preexisting conditions in these individuals, improve their access to outpatient obstetrical and medical care, and prepare them for when ED visits occur.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

et al. 2023

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“…30 We used billing codes to identify prenatal care visits and receipt of fetal anatomy ultrasound, according to Ontario Ministry of Health billing code definitions 31 and previously published work (Appendix 1, Supplemental Table 5). 32 , 33…”

Section: Methodsmentioning

confidence: 99%

Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study

Evans¹,

Ray²,

Austin³

et al. 2023

CMAJ

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Background: Canada has 2 main streams of resettlement: government-assisted refugees and privately sponsored refugees, whereby citizens can privately sponsor refugees and provide resettlement services, including health care navigation. Our objective was to compare receipt of adequate prenatal care among privately sponsored and government-assisted refugees. Methods: This population-based study used linked health administrative and demographic databases. We included all resettled refugees classified as female who landed in Ontario, Canada, between April 2002 and May 2017, and who had a live birth or stillbirth conceived at least 365 days after their landing date. Our primary outcome — adequacy of prenatal care — was a composite that comprised receipt of a first-trimester prenatal visit, the number of prenatal care visits recommended by the Society of Obstetricians and Gynaecologists of Canada and a prenatal fetal anatomy ultrasound. We accounted for potential confounding with inverse probability of treatment weighting, using a propensity score. Results: We included 2775 government-assisted and 2374 privately sponsored refugees. Compared with privately sponsored refugees (62.3% v. 69.3%), government-assisted refugees received adequate prenatal care less often, with a weighted relative risk of 0.93 (95% confidence interval 0.88–0.95). Interpretation: Among refugees resettled to Canada, a government-assisted resettlement model was associated with receiving less adequate prenatal care than a private sponsorship model. Government-assisted refugees may benefit from additional support in navigating health care beyond the first year after arrival.

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“…2017; Nishat et al . 2022) and have been reported to be at risk for reproductive hazards, such as caesarean birth and perinatal complications (e.g. Höglund et al .…”

Section: Introductionmentioning

confidence: 99%

Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population

Schuengel

Cuypers

Bakkum

et al. 2022

J intellect Disabil Res

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BackgroundResearch in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes.MethodsSecondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18–49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under‐identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands.ResultsWomen with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37–1.61] and became somewhat more often pregnant (95% CI OR = 1.06–2.30) than women from the general population, adjusting for age difference and follow‐up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26–1.99).ConclusionsWomen with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision‐making.

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Prenatal Care Adequacy Among Women With Disabilities: A Population-Based Study

Cited by 16 publications

References 43 publications

Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study

Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population

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