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

Abstract

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.

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

“…Twenty-three studies, representing 8,514,356 women in 19 distinct cohorts (including 1 US study that examined 4 states separately), 50 met our inclusion criteria and were included in the qualitative synthesis. Three articles from Canada [44][45][46] and 9 from the United States representing 3 different investigations (2 using California administrative data, 49,53 5 using the Pregnancy to Early Life Longitudinal Data System, 47,48,56,58,59 and 2 using the Pregnancy Risk Assessment Monitoring System for Rhode Island 57,61 ) used the same data sources and had fully or partially overlapping samples and study periods. Table 3 describes the studies' characteristics.…”

“…54,57,61,63,64 Studies had similar exclusion criteria, which mainly related to the exclusion of multiple gestations, stillbirths, and extremes of maternal age and gestational age. Studies had as few as 68 participants 60 and as many as 4,610,955 participants, 49 with all but 2 studies 55,60 having a sample of more than 2000 women.…”

“…51,55e57,61,66 Risk of bias of included studies Table 1 describes the quality of included studies. Studies were rated overall as having strong (n ¼ 4), 45,49,52,53 moderate (n ¼ 6), 46e48,58,59,65 or weak quality (n ¼ 13). 44,50,51,54-57,60e64,66 Five studies were cross-sectional 54,57,61,63,64 and had high risk of bias because of their design.…”

“…51,55e57,61,66 The majority (n ¼ 17) controlled for demographics such as age, ethnicity, and parity. 44-50,52e54,58-60,62e65 Nearly half (n ¼ 11) controlled for socioeconomic status (eg, income, education, employment) [44][45][46][47][48][49][50]53,58,59 and chronic disease (eg, obesity, diabetes) and/or mental illness (n ¼ 11). 45e50, 52,53,58,59,62 Few studies (n ¼ 6) controlled for lifestyle behaviors such as smoking, 47,48,50,52,58,59 and even fewer (n ¼ 5) controlled for measures of social support such as marital status.…”

Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States

“…1,2 Research to date has demonstrated disparities for women with disabilities in prenatal care utilization and satisfaction with prenatal care, preterm birth, having infants small for gestational age, and high rates of cesarean deliveries. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The majority of this research is based on delivery records or surveys like the Pregnancy Risk Assessment Monitoring System (PRAMS), which contain only live birth outcomes and therefore do not reflect early pregnancy loss or miscarriage. Thus, considerably less is known about the association between disability and miscarriage.…”