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Harkins SE, Barcelona V. An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities. J Adv Nurs 2024. [PMID: 38969486 DOI: 10.1111/jan.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM(S) To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities. DESIGN Discussion paper. METHODS We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health. DATA SOURCES We conducted a systematic review of literature published from 2001 to 2024 in four databases. RESULTS Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes. CONCLUSION The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women. IMPLICATIONS FOR NURSING Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps. IMPACT The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.
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Affiliation(s)
- Sarah E Harkins
- Columbia University School of Nursing, New York, New York, USA
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Asim M, Hameed W, Sohail MM, Saleem S, Hayward M, Turan JM. Barriers and facilitators to perinatal care of women with disabilities in lower- and middle-income countries: a study protocol for scoping review of qualitative studies. BMJ Open 2024; 14:e079605. [PMID: 38926146 PMCID: PMC11216051 DOI: 10.1136/bmjopen-2023-079605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The Sustainable Development Goals have put emphasis on equitable healthcare access for marginalised groups and communities. The number of women with disabilities (WWD) to marry and have children is rapidly increasing in low- and middle-income countries (LMICs). However, these women experience multifaceted challenges to seeking perinatal care in LMICs. The objective of this scoping review is to document key facilitators and barriers to seeking perinatal care by WWD. We also will propose strategies for inclusive perinatal healthcare services for women with disabilities in LMICs. METHODS We will conduct a scoping review of peer-reviewed and grey literature (published reports) of qualitative and mixed-methods studies on facilitators and barriers to seeking perinatal care for women with functional disabilities from 2010 to 2023 in LMICs. An electronic search will be conducted on Medline/PubMed, Scopus and Google Scholar databases. Two researchers will independently assess whether studies meet the eligibility criteria for inclusion based on the title, abstract and a full-text review. ETHICS AND DISSEMINATION This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at conferences related to reproductive health, disability and inclusive health forums.
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Affiliation(s)
- Muhammad Asim
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Malik Muhammad Sohail
- Center for Religion, Science and Social Wellbeing, Department of Sociology, University of Chakwal, Chakwal, Punjab, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Mark Hayward
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, The University of Texas at Austin, Austin, Texas, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Alam MB, Rana MS, Kabir MA, Khanam SJ, Khan MN. Pattern of contraceptive use among reproductive-aged women with disabilities in Bangladesh: Evidence from multiple indicator cluster survey 2019. Disabil Health J 2024:101651. [PMID: 38866623 DOI: 10.1016/j.dhjo.2024.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/16/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Contraception is crucial for reproductive-aged women with disabilities, empowering them to manage reproductive choices and enhancing overall health, autonomy, and well-being. OBJECTIVE The objective of this study was to examine the usage patterns of contraceptive methods among reproductive-aged women with disabilities in Bangladesh. METHODS We analyzed data from 47,465 reproductive-aged women from the 2019 Bangladesh Multiple Indicator Cluster Survey. Outcome variables included contraceptive usage patterns, grouped into any contraceptive methods, any modern contraceptive methods, and any traditional contraceptive methods. The primary explanatory variable considered was disabilities level (women with no disabilities, women with moderate disabilities, and women with severe disabilities), along with types of disabilities. A multilevel mixed-effects logistic regression model was used to assess associations between outcomes and explanatory variables while accounting for confounding. RESULTS The prevalence of any contraceptive methods use was 66.4 %, declining to 54 % among women with severe disabilities. The odd of modern contraception use was 31 % lower (aOR, 0.69, 95 % CI, 0.65-0.73) among women with moderate disabilities and 47 % lower (aOR, 0.53, 95 % CI, 0.47-0.60) among those with severe disabilities, compared to women with no disabilities. Within the individual domains of disabilities, those with vision, walking, cognitive, and self-care-related disabilities reported lower odds of modern contraception uptake than those with no disabilities. CONCLUSIONS The study highlights that women with disabilities use contraceptives less often, increasing vulnerability to unintended and short interval pregnancies and unsafe abortion. Strengthening family planning and prioritizing women with disabilities for modern contraceptives are vital.
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Affiliation(s)
- Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Shohel Rana
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Shimlin Jahan Khanam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
| | - Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh.
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Eliason EL, Bellerose M. Changes in postpartum insurance and care use by disability status during the COVID-19 pandemic. Disabil Health J 2024; 17:101581. [PMID: 38233252 DOI: 10.1016/j.dhjo.2024.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND People with disabilities face unique health needs and barriers to perinatal care. The pandemic may have worsened health care access disparities, while pandemic-era Medicaid provisions potentially improved access via increased insurance coverage. OBJECTIVE We assessed changes in postpartum insurance, visits, and reproductive health care during the COVID-19 public health emergency (PHE) and PHE Medicaid provisions among individuals with disabilities versus individuals without disabilities. METHODS We used the 2019-2020 Pregnancy Risk Assessment Monitoring System survey and Disability Supplement to compare changes in postpartum outcomes by disability status during COVID-19. Adjusted regression models included an interaction term between disability status and postpartum exposure to the PHE. Comparative differences were examined overall, among low-income respondents, and among respondents with Medicaid-paid deliveries. RESULTS During the PHE, there was a significant increase in postpartum Medicaid by 7.1% points (95 % CI: 0.6, 13.6) and a decrease in uninsurance by 5.2% points (95 % CI: -9.0, -1.4) among respondents with disabilities relative to those without. There was a significant increase in postpartum contraception during the PHE among respondents with disabilities relative to those without by 6.3% points (95 % CI: -0.1, 12.5). The PHE was associated with larger increases in postpartum Medicaid and larger decreases in postpartum uninsurance among low-income respondents, with similar estimates among respondents with Medicaid-insured deliveries. CONCLUSIONS During the COVID-19 PHE, individuals with disabilities saw increased postpartum insurance and improved contraceptive use. As PHE Medicaid provisions are rolled back, these differential improvements should be factored into decisions about postpartum Medicaid eligibility.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
| | - Meghan Bellerose
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
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Newby-Kew A, Snowden JM, Akobirshoev I, Valentine A, Mitra M, Horner-Johnson W. Pre-Pregnancy Health Risks by Presence and Extent of Disability, 2019-2020. Am J Prev Med 2024; 66:655-663. [PMID: 38008133 DOI: 10.1016/j.amepre.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Prior studies have shown that, compared to non-disabled women, women with disabilities have a higher burden of preconception mental and physical health risks that are associated with adverse pregnancy outcomes. This cross-sectional study assesses how the extent of disability relates to pre-pregnancy health risks. METHODS This study used 2019-2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n=37,006). In 2023, associations between extent of disability (none [reference group], some difficulty, or a lot of difficulty) and preconception health risks were examined using multivariable Poisson regression with robust standard errors to calculate adjusted prevalence ratios (aPRs) and 95% CIs while controlling for sociodemographic characteristics. Preconception health risks included smoking, heavy drinking, high blood pressure, diabetes, no multivitamin use, and experiencing physical abuse, depression, or obesity. Individual risks were analyzed, as well as the total number of risks experienced. RESULTS Of respondents, 33.6% had some difficulty and 6.3% had a lot of difficulty. The likelihood of experiencing preconception health risks increased with extent of disability. Compared to respondents with no difficulty, those with some or a lot of difficulty had a higher prevalence of experiencing 1-2 health risks (aPR=1.13, 95% CI 1.09, 1.18; aPR=1.20; 95% CI 1.53, 2.25) and 3+ health risks (aPR=1.86, 95% CI 1.53, 2.25; aPR=2.42, 95% CI 1.98, 2.97), respectively. CONCLUSIONS Disabled women, especially those with more difficulty, are vulnerable to preconception health risks that could potentially be mitigated before conception. These findings highlight the need for enhanced efforts to support preconception health of disabled women.
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Affiliation(s)
- Abigail Newby-Kew
- Oregon Health & Science University and Portland State University School of Public Health; Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Jonathan M Snowden
- Oregon Health & Science University and Portland State University School of Public Health; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Willi Horner-Johnson
- Oregon Health & Science University and Portland State University School of Public Health; Institute on Development and Disability, School of Medicine, Oregon Health & Science University, Portland, Oregon.
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Powell RM. Reproductive justice for disabled people post-Dobbs: A call-to-action for researchers. Disabil Health J 2024; 17:101572. [PMID: 38071137 DOI: 10.1016/j.dhjo.2023.101572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 04/09/2024]
Abstract
The recent Supreme Court ruling in Dobbs v. Jackson Women's Health Organization endangers reproductive freedom, particularly for marginalized communities, including disabled people. Disability and health equity researchers possess unique insights into the needs and experiences of disabled people, making our involvement crucial in response to the Dobbs decision. Accordingly, guided by disability justice and reproductive justice principles, researchers should undertake disability-inclusive studies on the consequences of abortion restrictions, advocate for policy changes that uphold the reproductive autonomy of disabled people, and collaborate with disability-led movements advocating for reproductive freedom. Indeed, it is imperative for researchers to actively promote the inclusion and self-determination of disabled people regarding their reproductive health and well-being. Given the escalating threats to reproductive freedom and their profound impact on disabled people, there has never been a more pivotal moment for disability and health equity researchers to join the fight for reproductive justice.
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Affiliation(s)
- Robyn M Powell
- University of Oklahoma College of Law, 300 Timberdell Road, Norman, OK 73019, USA; The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02453, USA.
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O'Brien KE, Rosen MW, Ernst SD. Obstetric and Gynecologic Care for Individuals with Disabilities. Obstet Gynecol Clin North Am 2024; 51:43-56. [PMID: 38267130 DOI: 10.1016/j.ogc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This article explores the inequities experienced by individuals with disabilities when accessing obstetric and gynecologic care. The unique needs, abilities, and barriers to care are reviewed, as well as recommendations for provision of care to people with disabilities.
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Affiliation(s)
- Kathleen E O'Brien
- Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48104, USA.
| | - Monica Woll Rosen
- Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48104, USA
| | - Susan Dwyer Ernst
- Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48104, USA
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Vainder M, Ray JG, Lunsky Y, Fung K, Vigod SN, Havercamp SM, Parish SL, Brown HK. Physical disability and venous thromboembolism during pregnancy and the postpartum period: a population-based cohort study. J Thromb Haemost 2023; 21:1882-1890. [PMID: 37031753 DOI: 10.1016/j.jtha.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/06/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Pregnancy and the postpartum period are a high-risk time for venous thromboembolism (VTE). Decreased mobility is also a major risk factor. However, the risk of peripregnancy VTE among individuals with physical disabilities is unknown. OBJECTIVES To compare the risk of peripregnancy VTE between people with a physical disability and those without a physical disability. METHODS This population-based cohort study comprised all births in Ontario, Canada, from 2007 to 2018. Physical disability was defined as a condition diagnosed before conception that was likely to result in restricted mobility. Modified Poisson regression was used to compare the risk of VTE during pregnancy and up to 6 weeks postpartum between people with a physical disability and those without a physical disability. Adjusted relative risks (aRRs) were calculated, controlling for demographics, history of VTE, thrombophilia, and other comorbidities. An additional analysis was used to evaluate the risk of peripregnancy VTE among people with physical disabilities who used a mobility aid. RESULTS Of 1 220 822 eligible people, 13 791 (1.1%) had a physical disability. VTE occurred during pregnancy or up to 6 weeks of the postpartum period in 0.85% of the individuals with a physical disability and 0.47% of those without a physical disability (aRR, 1.52; 95% CI, 1.26-1.83). The rate of VTE was notably higher in those with a physical disability requiring a mobility aid (3.0%), generating an aRR of 3.05 (95% CI, 1.45-6.41), than in those without a physical disability. CONCLUSION Pregnant people with a physical disability, especially those using a mobility aid, are at an increased risk of VTE. Anticoagulant prophylaxis could be considered in this group, especially in the presence of additional risk factors.
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Affiliation(s)
- Marina Vainder
- Department of Obstetrics & Gynaecology, University of Toronto, Toronto, Ontario, Canada. https://twitter.com/MVainder
| | - Joel G Ray
- ICES, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yona Lunsky
- ICES, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Simone N Vigod
- ICES, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Susan M Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hilary K Brown
- ICES, Toronto, Ontario, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Pérez-Curiel P, Vicente E, Morán ML, Gómez LE. The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20021587. [PMID: 36674341 PMCID: PMC9864803 DOI: 10.3390/ijerph20021587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 05/31/2023]
Abstract
Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.
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Affiliation(s)
- Patricia Pérez-Curiel
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - Eva Vicente
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - M. Lucía Morán
- Department of Education, University of Cantabria, Av./de los Castros, 52, 39005 Santander, Spain
| | - Laura E. Gómez
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
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Alhusen JL, Hughes RB, Lyons G, Laughon K. Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System. J Adv Nurs 2023; 79:223-233. [PMID: 36320150 PMCID: PMC9795828 DOI: 10.1111/jan.15482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/04/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability. DESIGN We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy. RESULTS Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities. CONCLUSION Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes. IMPACT Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring. PATIENT OR PUBLIC CONTRIBUTION We thank our Community Advisory Board members who have been instrumental in the conception of this study.
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Affiliation(s)
- Jeanne L. Alhusen
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Rosemary B. Hughes
- University of Montana Rural Institute for Inclusive Communities, Missoula, Montana, USA
| | - Genevieve Lyons
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Kathryn Laughon
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
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Morbidity and rehospitalization postpartum among women with epilepsy and their infants: A population-based study. Epilepsy Behav 2022; 136:108943. [PMID: 36252288 DOI: 10.1016/j.yebeh.2022.108943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We compared the relative occurrence of selected pregnancy outcomes and postpartum rehospitalizations among women with and without epilepsy and their infants. Using linked vital-hospital discharge records of women with deliveries in Washington State 1987-2014, comparisons were made overall, by epilepsy type, and by time periods related to antiepileptic drug (AED) marketing changes. METHODS This population-based retrospective cohort study identified women with, and without epilepsy per diagnosis codes in the hospital discharge record from among all deliveries during 1987-2014 to examine maternal and infant outcomes, rehospitalization and mortality <2 years postpartum. Relative risks (RRs) and 95 % confidence intervals (CI) overall, and by epilepsy type were calculated using Poisson regression. We assessed the validity of epilepsy identification based on diagnosis codes by conducting a medical chart review for a sample of women. RESULTS Women with epilepsy had increased risks of preeclampsia (RR 1.23; 95 % CI 1.08-1.41) and gestational diabetes (RR 1.18; 95 % CI 1.02-1.36). Their infants had increased malformation (RR 1.23; 95 % C: 1.08-1.42) and small for gestational age (SGA, RR 1.39; 95 % CI 1.25-1.54) risks, and were nearly three times as likely to not be breastfed. Affected mothers (RR 5.25; 95 % CI 2.46-11.23) and their infants (RR 1.64, 95 % CI 1.41-1.89) required more ICU admissions during the delivery hospitalizations, and more postpartum rehospitalization, with greatest risk in the first six months. Maternal mortality < 2 years after delivery was increased (RR 7.11; 95 % CI 2.47-20.49). Increased risks were observed for all epilepsy subtypes for nearly all outcomes examined. Risks of preterm delivery and low birthweight increased over time (p <.05). Suggestive, but not statistically significant temporal decreases in risks of gestational diabetes and malformations and increased risk of preterm labor were noted. We observed high sensitivity of diagnosis codes for identifying pregnant women with epilepsy. CONCLUSION These population-based results emphasize the need for frequent postpartum monitoring of women with epilepsy. Increases in risks of low birthweight and preterm delivery over time are of concern. Possible temporal changes in other outcomes warrant further investigation.
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Khanna A, Smith LD, Parish SL, Mitra M. Pregnancy recommendations from women with intellectual and developmental disabilities to their peers. Disabil Health J 2022; 15:101343. [PMID: 35739053 DOI: 10.1016/j.dhjo.2022.101343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND As recent as the mid-twentieth century, eugenics practices on women with intellectual and developmental disabilities were commonplace. Deinstitutionalization has led to an increasing proportion of women with intellectual and developmental disabilities living in the community and becoming pregnant. Previous research has reported barriers to maternal health care (i.e., perceived provider stigma, inadequate communication, stress surrounding child protective services involvement, and financial strain). Research shows that this population is at increased risk of adverse outcomes including preterm delivery, low birth weight babies, and maternal mortality. OBJECTIVE/HYPOTHESIS This study aimed to explore recommendations from mothers with intellectual and developmental disabilities for other women to potentially improve pregnancy experiences for this population. METHODS We conducted semi-structured individual interviews among 16 women with intellectual and developmental disabilities. Data were coded using a content analysis process and iteratively analyzed using inductive and deductive techniques to determine emergent themes. RESULTS Participants offered recommendations for navigating pregnancy to their peers who are pregnant, or thinking about becoming pregnant. Themes included: (1) planning for birth; (2) advocating at the point-of-care; (3) seeking supports and services; (4) interacting with child protective services; (5) communicating with providers; and (6) exhibiting resilience. CONCLUSION Our study highlights recommendations for improving pregnancy experiences of women with intellectual and developmental disabilities. Informed by the lived pregnancy experiences of our participants, these recommendations can inform clinician training, new guidelines, and services to support and improve pregnancy experiences for women with intellectual and developmental disabilities.
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Affiliation(s)
- Aishwarya Khanna
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, 200 Spring Rd, Bedford, MA, 01730, USA
| | - Lauren D Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA.
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA, 23284, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Horner-Johnson W, Garg B, Darney BG, Biel FM, Caughey AB. Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities. Paediatr Perinat Epidemiol 2022; 36:759-768. [PMID: 35437812 PMCID: PMC9398919 DOI: 10.1111/ppe.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Little is known about severe maternal morbidity (SMM) among women with disabilities. OBJECTIVE We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities. METHODS We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23-42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate-adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes. RESULTS Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities). CONCLUSION As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR
- OHSU-PSU School of Public Health, Portland, OR
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Blair G. Darney
- OHSU-PSU School of Public Health, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Frances M. Biel
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
- Present affiliation: OCHIN, Inc., Portland, OR
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Signore C. Pregnancy in women with disabilities: Past, present and future. Paediatr Perinat Epidemiol 2022; 36:769-770. [PMID: 35643893 PMCID: PMC9398999 DOI: 10.1111/ppe.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Caroline Signore
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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