Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities

Abstract

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

Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities

“…This study builds on recent findings indicating that women with disabilities are at greater risk for SMM and/or mortality than women without disabilities 11–13 Brown et al 13 also found that risk was greater for women with IDD than for those with physical or sensory disabilities. We found similar patterns of increased risk for SMM among women with disabilities overall, and greater risk among women with IDD than among those with physical disabilities as a whole.…”

“…For example, prior research has found increased odds of gestational hypertension and/or preeclampsia among women with IDD, 12,[20][21][22][23]25 and increased risk of gestational diabetes, preeclampsia and VTE among women with physical disabilities. 12,17 We found similar patterns with regard to gestational diabetes and preeclampsia. Numbers were small for our analyses of VTE; nonetheless, the pattern we observed was worrying.…”

“…11 Another U.S. study found increased risk of several components of SMM among women with IDD, physical or sensory disabilities. 12 A study using data from Ontario, Canada, found more than twice the risk of SMM or maternal mortality among women with any disability as compared to those without disabilities. 13 While the latter two studies provided some data on differences by disability type, both grouped vision and hearing disability together.…”

Pregnancy in women with disabilities: Past, present and future

“…1 Recently, two different groups have shown that severe maternal morbidity (SMM) is increased among women with disabilities across the spectrum of physical, intellectual, developmental and sensory disabilities. 2,3 In this issue of Paediatric and Perinatal Epidemiology, Horner-Willi and colleagues 4 essentially confirm these findings and make an important addition by conducting analyses in subgroups of individuals with disabilities, for example considering people with vision and hearing impairments separately and stratifying analyses for physical disabilities by the underlying cause. Using a large, population-based California dataset, they found an almost threefold increased risk of SMM among WWD overall.…”

“…At the time of the workshop, pregnancy rates among women with disabilities were unknown; we now know that pregnancy prevalence is comparable between women with and without disabilities 7 . In 2010, while there were ample data showing that women with disabilities, in general, were more likely to have socioeconomic disadvantages, difficulty accessing medical care (especially reproductive care) and unmet medical needs, we did not know whether these factors applied specifically to pregnant women with disabilities; we now know that they do 1–3 …”