Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities

Perinatal mental health and risk of severe maternal morbidity in women with physical disabilities, Massachusetts 2003-2015

BACKGROUND

Perinatal mental health and substance use disorders contribute to adverse maternal outcomes. Women with disabilities experience increased risk for severe maternal morbidity (SMM). No studies have examined the association between perinatal mental health and SMM risk in women with physical disabilities.

OBJECTIVE

To examine the association between perinatal mental health and substance use disorders and SMM risk in women with physical disabilities.

METHODS

We analyzed delivery hospitalizations from 2003 to 2015 from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system. We identified physical disability using International Classification of Diseases, Ninth Revision codes. Perinatal mental health status was based on the presence of at least one emergency department visit, observational, or in-patient stay attributed to a mental health or substance use disorder anytime from gestation to delivery. We used modified Poisson regressions to obtain risk ratios (RR) for SMM in women with either a physical disability or no disability by perinatal mental health status. Non-disabled women with no perinatal mental health or substance use disorder visit served as the referent group.

RESULTS

Deliveries in women with no physical disability and a perinatal mental health visit were not associated with risk of SMM. Compared to the referent group, women with a physical disability and a perinatal mental health or substance use disorder visit had greater risk of both SMM (RR = 1.84, 95 % CI:1.32-2.56), and nontransfusion SMM (RR = 2.35 1.52, 3.64), after adjusting for demographic and socioeconomic characteristics.

CONCLUSIONS

Increased attention should be paid to perinatal mental health status in women with physical disabilities.

Pre-Pregnancy Health Risks by Presence and Extent of Disability, 2019-2020

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.

Perinatal health framework for people with intellectual disability

We propose a framework for guiding research on perinatal health in people with intellectual disability (ID). We developed this framework based on the perinatal health framework for people with physical disabilities, American Association on Intellectual and Developmental Disabilities conceptual framework of human functioning, disability reproductive justice framework, trauma-informed care, and socio-ecological model. The framework reflects health outcomes of birthing people with ID and their infants that result from interactions of factors across the life course at policy (health, social, and disability policies), community (attitudes, social and physical environment), institutional (health care delivery-related factors, access to information/resources), interpersonal (social determinants of health/histories of trauma, social support, interactions with service-providers), and individual levels (demographics, intellectual functioning, adaptive behavior, health conditions, genetic factors, psychosocial factors, health behaviors). This framework will facilitate research to identify factors leading to perinatal health disparities in people with ID and development and evaluation of resources to address them.

Reproductive justice for disabled people post-Dobbs: A call-to-action for researchers

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.

Severe maternal morbidity in deaf or hard of hearing women in the United States

OBJECTIVE

Prior studies on severe maternal morbidity (SMM) have often excluded women who are deaf or hard of hearing (DHH), even though they are at increased risk of pregnancy complications and adverse birth outcomes. This study compared rates of SMM during delivery and postpartum among DHH and non-DHH women.

METHODS

This nationally representative retrospective cohort study used hospital discharge data from the 2004-2020 Health Care and Cost Utilization Project Nationwide Inpatient Sample. The risk of SMM with and without blood transfusion during delivery and postpartum among DHH and non-DHH women were compared using modified Poisson regression analysis. The study was conducted in the United States in 2022-2023.

RESULTS

The cohort included 9351 births to DHH women for the study period, and 13,574,382 age-matched and delivery year-matched births to non-DHH women in a 1:3 case-control ratio. The main outcomes were SMM and non-transfusion SMM during delivery and postpartum. Relative risks were sequentially adjusted for sociodemographic characteristics, hospital-level characteristics, and clinical characteristics. In unadjusted analyses, DHH women were at 80% higher risk for SMM (RR = 1.81, 95% CI 1.63-2.02, p < 0.001) during delivery and postpartum compared to non-DHH women. Adjustment for socio-demographic and hospital characteristics attenuated risk for SMM (RR = 1.54, 95% CI 1.38-1.72, p < 0.001). Adjustment for the Elixhauser comorbidity score further attenuated the risk of SMM among DHH women (RR = 1.13, 95% CI 1.01-1.26, p < 0.05).

CONCLUSION

The findings of this study demonstrate a critical need for inclusive preconception, prenatal, and postpartum care that address conditions that increase the risk for SMM among DHH people.

Mothers with Intellectual/Developmental Disabilities and Behavioral Health Conditions and Community Experts Provide Recommendations for Treatment/Services, Systems, and Research

Mothers with intellectual and developmental disabilities (IDD) are vulnerable to perinatal complications and adverse outcomes. Their vulnerabilities may also be exacerbated by co-occurring behavioral health (BH) conditions. Their wellbeing may be compromised by a lack of tailored treatments or by treatments and services that are inaccessible, irrelevant, and/or ineffective. A five-session virtual Ideas Lab workshop series was implemented to bring together diverse community experts (n = 30), including mothers with IDD/BH, to discuss the experiences of mothers and set priorities for treatment/services, systems, and research. Participants completed background and evaluation surveys and brainstormed, grouped, and ranked items of importance, which fell into two broad categories: (1) cross-cutting themes drawn from lived experience with recommendations applicable to all substantive domains (i.e., accessibility, diversity, adverse experiences and trauma, and trust) and (2) substantive themes with specific recommendations for treatment/services and systems (i.e., services and supports, peer support, provider practices and training, and systems navigation/transformation). Research recommendations were generated in all discussions and emerged in relation to all themes, underscoring the importance of including mother-driven questions and priorities in research agendas and strengthening researcher training and skills to engage mothers with IDD/BH and other community members actively, and in meaningful ways.

The prevalence of intimate partner violence against women with disabilities: a systematic review of the literature

PURPOSE

Although systematic reviews have already been conducted on violence and disability, the evidence is not conclusive in Intimate Partner Violence (IPV). This study examined the prevalence of IPV in women with disabilities, taking account of the different types of violence and disability.

METHODS

We performed a search in five databases. We included observational studies that analysed the frequency of IPV in women with disabilities compared to women without. Two independent reviewers selected and assessed studies. We made a qualitative synthesis according to the type of IPV analysed in relation to disability.

RESULTS

We identified 26 articles. The frequency and risk of IPV were greater in women with disabilities than in those without. All of the articles that studied financial violence, 81.3% of those that studied physical violence, 78.5% of those that studied psychological violence, 75% of those that studied physical/sexual violence, 73.3% of those that studied sexual violence and 50% of those that studied any type of violence found a significant association whit disability.

CONCLUSIONS

Women with disabilities are at higher risk of IPV. Rehabilitation centers and its professionals must have a leading role in the identification of these situations and this should be considered in IPV prevention plans.Implications for rehabilitationPeople with disabilities are at higher risk of multiple types of violence.Violence against women with disabilities therefore involves two public health issues interacting simultaneously.Rehabilitation centers and its professionals should have a leading role in the identification of IPV in women with disabilities.IPV prevention plans should consider rehabilitation centers and its professionals as a main component of interventions in women with disabilities.

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

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.

Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities

Background

Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities.

Method

We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships.

Results

The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training).

Conclusions

Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.