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Sharma R, Kumar A, Suri V, Kaur S, Singh AJ. An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India. Int J Gynaecol Obstet 2023; 163:818-824. [PMID: 37345270 DOI: 10.1002/ijgo.14931] [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: 08/04/2022] [Revised: 03/14/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. METHODS This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. RESULTS Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. CONCLUSION Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.
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Affiliation(s)
- Ruchi Sharma
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Amar Jeet Singh
- Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Biggs MA, Schroeder R, Casebolt MT, Laureano BI, Wilson-Beattie RL, Ralph LJ, Kaller S, Adler A, Gichane MW. Access to Reproductive Health Services Among People With Disabilities. JAMA Netw Open 2023; 6:e2344877. [PMID: 38019515 PMCID: PMC10687653 DOI: 10.1001/jamanetworkopen.2023.44877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/14/2023] [Indexed: 11/30/2023] Open
Abstract
Importance People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown. Objective To assess the national prevalence of barriers to RH access experienced by people with disabilities. Design, Setting, and Participants This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services. Exposure Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains). Main Outcomes and Measures Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years. Results After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities. Conclusions and Relevance This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.
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Affiliation(s)
- M. Antonia Biggs
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Rosalyn Schroeder
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - M. Tara Casebolt
- Morrissey College of Arts and Sciences, Boston College, Chestnut Hill, Massachusetts
| | | | | | - Lauren J. Ralph
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Shelly Kaller
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Aliza Adler
- Innovating Education in Reproductive Health, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
| | - Margaret W. Gichane
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco
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Rosman AN, van der Vliet-Torij HWH, Hilberink SR. Trends in perinatal outcomes of women with chronic medical conditions: A 10-year population-based study in the Netherlands. Midwifery 2023; 118:103572. [PMID: 36587471 DOI: 10.1016/j.midw.2022.103572] [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: 06/22/2022] [Revised: 11/14/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To gain insight into perinatal outcomes in women with chronic medical conditions, in order to contribute to the optimization of personalized perinatal care. We hypothesize that women with a chronic medical condition have poorer perinatal outcomes than women without a known chronic medical condition. DESIGN Population-based study using data of the Netherlands Perinatal Registry between 2010-2019. SETTING Nationwide study in the Netherlands. PARTICIPANTS Pregnancies of women who were diagnosed with chronic medical conditions by a medical specialist before pregnancy (n=36,835), divided into seven sub-groups and a reference group of pregnancies of women without known chronic medical conditions (n=1,084,623). MEASUREMENTS AND FINDINGS The primary outcome measure was mode of birth. Secondary outcomes measures were onset of labour, preterm birth, asphyxia, Neonatal Intensive Care Unit (NICU) admission, and perinatal mortality. Spontaneous birth ranged from 45.0% (orthopaedic conditions) to 71.3% (neurological conditions) to 82.6% in the reference group. Assisted vaginal birth, planned caesarean birth, and emergency caesarean birth occurred significantly more in all groups compared to the reference group (p<0.001). Preterm birth was significantly more likely in the studied groups as well as perinatal asphyxia and NICU admission (all p<0.001). Adjusting for mode of birth, parity, age and ethnicity did not change the outcomes for the group of women with chronic medical conditions. Perinatal mortality was seen in all groups but in none of the separate groups significantly more than in the reference group. Descriptive statistics, univariate and multivariable logistic regression analyses were applied. KEY CONCLUSIONS Women with chronic medical conditions are more likely to experience preterm birth, caesarean births and NICU admission of the new-born. IMPLICATIONS FOR PRACTICE Knowledge about perinatal outcomes of women with chronic medical conditions is a first step for obstetrics care providers in order to optimize personalized care.
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Affiliation(s)
- Ageeth N Rosman
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands; Perined, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands.
| | | | - Sander R Hilberink
- Rotterdam University of Applied Sciences, Research Center of Innovations in Care, P.O. Box 25035, 30001 HA Rotterdam, The Netherlands
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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5
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Tang MB, Kung PT, Chiu LT, Tsai WC. Comparison of the use of prenatal care services and the risk of preterm birth between pregnant women with disabilities and those without disabilities: A nationwide cohort study. Front Public Health 2023; 11:1090051. [PMID: 36778582 PMCID: PMC9911428 DOI: 10.3389/fpubh.2023.1090051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The difficulties faced by pregnant women with disabilities in accessing health care may make them less likely to receive prenatal care. The aims of this study were to compare the number of prenatal services and the risk of preterm birth between pregnant women with and without disabilities. Methods A total of 2999 pregnant women aged ≥20 years with birth records in 2011-2014 in Taiwan were enrolled. Data were obtained from the Registration File for Physical and Mental Disabilities and the National Health Insurance Research Database. A 1:4 matching between pregnant women with disabilities and those without disabilities was performed. The logistic regression analysis with generalized estimating equations was used to analyze. Results The median of prenatal care services used by pregnant women with disabilities was 9.00 (interquartile range, IQR: 2.00). Pregnant women with disabilities used fewer services than those without disabilities (median, 10.00; IQR: 1.00). The disabled group (8.44%) had a significantly higher proportion of preterm births than did the non-disabled group (5.40%). The disabled group was at a 1.30 times higher risk of preterm births than was the non-disabled group. Conclusions Pregnant women with disabilities used significantly fewer prenatal care services and had a significantly higher risk of preterm birth than pregnant women without disabilities.
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Affiliation(s)
- Meng-Bin Tang
- Department of Public Health, Graduate Institute of Public Health, China Medical University, Taichung, Taiwan,Department of Health Services Administration, China Medical University, Taichung, Taiwan,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan,*Correspondence: Wen-Chen Tsai ✉
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Tucker CM, Bell N, Corbett CF, Lyndon A, Felder TM. Using medical expenditure panel survey data to explore the relationship between patient-centered medical homes and racial disparities in severe maternal morbidity outcomes. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221147380. [PMID: 36660909 PMCID: PMC9887166 DOI: 10.1177/17455057221147380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are persistent racial/ethnic disparities in the occurrence of severe maternal morbidity. Patient-centered medical home care has the potential to address disparities in maternal outcomes. OBJECTIVES To examine (1) the association between receiving patient-centered medical home care and severe maternal morbidity outcomes and (2) the interaction of race/ethnicity on patient-centered medical home status and severe maternal morbidity. DESIGN/METHODS Using 2007 to 2016 data from the Medical Expenditures Panel Survey, we conducted a cross-sectional study to estimate the association between receipt of care from a patient-centered medical home and the occurrence of severe maternal morbidity, and racial-specific (White, Black, Asian, Other) relative risks of severe maternal morbidity. Our study used race as a proxy measure for exposure racism. We identified mothers (⩾15 years) who gave birth during the study period. We identified patient-centered medical home qualities using 11 Medical Expenditures Panel Survey questions and severe maternal morbidities using medical claims, and calculated generalized estimating equation models to estimate odds ratios of severe maternal morbidity and 95% confidence intervals. RESULTS Among all mothers who gave birth (N = 2801; representing 5,362,782 US lives), only 25% received some exposure patient-centered medical home care. Two percent experienced severe maternal morbidity, and this did not differ statistically (p = 0.11) by patient-centered medical home status. However, our findings suggest a 85% decrease in the risk of severe maternal morbidity among mothers who were defined as always attending a patient-centered medical home (odds ratios: 0.15; 95% confidence interval:0.01-1.87; p = 0.14) and no difference in the risk of severe maternal morbidity among mothers who were defined as sometimes attending a patient-centered medical home (odds ratios: 1.00; 95% confidence interval:0.16-6.42; p = 1.00). There was no overall interaction effect in the model between race and patient-centered medical home groups (p = 0.82), or ethnicity and patient-centered medical home groups (p = 0.62) on the severe maternal morbidity outcome. CONCLUSION While the rate of severe maternal morbidity was similar to US rates, few mothers received care from a patient-centered medical home which may be due to underreporting. Future research should further investigate the potential for patient-centered medical home-based care to reduce odds of severe maternal morbidity across racial/ethnic groups.
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Affiliation(s)
- Curisa M Tucker
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA,Curisa M Tucker, Department of Pediatrics,
Stanford University School of Medicine, 3145 Porter Drive, Palo Alto, CA 94304,
USA.
| | - Nathaniel Bell
- College of Nursing, University of South
Carolina, Columbia, SC, USA
| | | | - Audrey Lyndon
- Rory Meyers College of Nursing, New
York University, New York, NY, USA
| | - Tisha M Felder
- College of Nursing, University of South
Carolina, Columbia, SC, USA
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Horner-Johnson W, Dissanayake M, Marshall N, Snowden JM. Perinatal Health Risks And Outcomes Among US Women With Self-Reported Disability, 2011-19. Health Aff (Millwood) 2022; 41:1477-1485. [PMID: 36130140 DOI: 10.1377/hlthaff.2022.00497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Women with disabilities experience elevated risk for adverse pregnancy outcomes. Most studies have inferred disabilities from diagnosis codes, likely undercounting disabilities. We analyzed data, including self-reported disability status, from the National Survey of Family Growth for the period 2011-19. We compared respondents with and without disabilities on these characteristics: smoking during pregnancy, delayed prenatal care, preterm birth, and low birthweight. A total of 19.5 percent of respondents who had given birth reported a disability, which is a much higher prevalence than estimates reported in US studies using diagnosis codes. Respondents with disabilities were twice as likely as those without disabilities to have smoked during pregnancy (19.0 percent versus 8.9 percent). They also had 24 percent and 29 percent higher risk for preterm birth and low birthweight, respectively. Our findings suggest that studies using diagnosis codes may represent only a small proportion of pregnancies among people with disabilities. Measurement and analysis of self-reported disability would facilitate better understanding of the full extent of disability-related disparities, per the Affordable Care Act.
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Ward CA, Goss KD, Angles JS, Turk MA. The Use of Self-Reported Functional Limitation to Examine Pregnancy and Reproductive Health Experiences in a National Sample of Women. WOMEN'S HEALTH REPORTS 2022; 3:420-429. [PMID: 35559358 PMCID: PMC9081017 DOI: 10.1089/whr.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/13/2022]
Abstract
Context: Methods: Results: Conclusions:
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Affiliation(s)
- Caitlin A. Ward
- College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Katherine D. Goss
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John S. Angles
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA
| | - Margaret A. Turk
- Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA
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Richard CL, Love BL, Boghossian N, Hardin J, McDermott S. Are pregnant women with disability prescribed opioids more and at higher dosages than those without disability?: a retrospective cohort study of South Carolina Medicaid beneficiaries. Disabil Health J 2022; 15:101288. [DOI: 10.1016/j.dhjo.2022.101288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 01/05/2023]
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Deierlein AL, Antoniak K, Chan M, Sassano C, Stein CR. Pregnancy-related outcomes among women with physical disabilities: A systematic review. Paediatr Perinat Epidemiol 2021; 35:758-778. [PMID: 34431112 DOI: 10.1111/ppe.12781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. OBJECTIVES To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. DATA SOURCES We searched Medline and CINAHL for articles published January 2009-April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION AND DATA EXTRACTION Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. SYNTHESIS All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). RESULTS A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. CONCLUSIONS Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.
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Affiliation(s)
| | | | - Melany Chan
- School of Global Public Health, New York University, New York, NY, USA
| | - Caprice Sassano
- School of Global Public Health, New York University, New York, NY, USA
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at New York University, New York, NY, USA
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11
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Aslan E, Yılmaz B, Acar Z. Reproductive Health, Sexual Function and Satisfaction Levels in Women with Physical, Hearing, and Visual Disabilities. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Associations between Disability and Infertility among U.S. Reproductive-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063202. [PMID: 33808812 PMCID: PMC8003727 DOI: 10.3390/ijerph18063202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18–49 years without history of hysterectomy or oophorectomy (NHANES, 2013–2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31–2.40)). Similar findings were observed for sensory (2.32 (1.52–3.52)) and cognitive disabilities (1.77 (1.28–2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32–1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.
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Signore C, Davis M, Tingen CM, Cernich AN. The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality. J Womens Health (Larchmt) 2021; 30:147-153. [PMID: 33216671 PMCID: PMC8020507 DOI: 10.1089/jwh.2020.8864] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
It is estimated that 1 in 4 women in the United States live with a disability, and using population-based estimates, 10-12% of women of childbearing age have a disability. There are limited data to suggest that women with disabilities experience higher rates of or risks for adverse outcomes related to pregnancy, delivery, and access to appropriate postpartum care. Research on specific disabling conditions demonstrates variable risk for syndromes that threaten the health of the mother, such as preeclampsia, infection, and coagulation disorders. Much of the literature suggests that normal, healthy pregnancy is possible but points to the need for tailored information for patients and providers about the intersection of their condition with pregnancy and specific care needs. Given the lack of systematic evidence in this area across conditions and functional impairments, more research is needed to clarify the interaction of specific disabilities with pregnancy and provide evidence-based information to the field to decrease the risks to mothers and their infants. This article will provide an overview of conditions that contribute to maternal morbidity and mortality as they relate to pregnancy in women with disabilities and provide resources to the field to further the investigation of this area.
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Affiliation(s)
- Caroline Signore
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Maurice Davis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Candace M. Tingen
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Alison N. Cernich
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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14
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Development of a new pregnancy informational and decisional needs survey for women with physical disabilities. Disabil Health J 2020; 14:101056. [PMID: 33451968 DOI: 10.1016/j.dhjo.2020.101056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND While the literature on pregnancy and disability is growing, generating important knowledge of barriers to care and health risks, there is limited literature on pregnancy decision-making and informational needs. Such knowledge is critical for the development of interventions to mitigate the challenges women with disabilities and health care providers face in making this important decision. OBJECTIVE /Hypothesis: Develop a survey of pregnancy decisional and informational needs of women with physical disabilities. METHODS We developed a conceptual framework that guided item writing, defined the characteristics of the target population, engaged stakeholders with disabilities to collaborate with investigators, and tested the interpretability and relevance of items, and preferred mode of responding (online vs. telephone). A total of 123 women participated in cognitive interviews (N = 13), mode testing (N = 10), or survey data collection (N = 114). RESULTS Instructions, three screening questions, and 156 items were tested in one round of 17 cognitive interviews; 25 items were deleted, 94 were revised, and 37 items were retained without changes. The final version of the survey included six sub-sections: the experience of making a decision; information about pregnancy and disability; things affecting a decision; knowing what is important; support for making a decision; and working with health care providers. CONCLUSIONS The overall performance of the survey supported its content validity and utility as a useful way to gather information about the pregnancy decision-making experience and informational needs of women with physical disabilities.
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 PMCID: PMC7703246 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D. Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H. Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L. Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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16
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Abstract
OBJECTIVE To describe the number of admissions of pregnant people to U.S. jails and the outcomes of pregnancies that end in custody. METHODS We prospectively collected pregnancy data from six U.S. jails, including the five largest jails, on a monthly basis for 12 months. Jails reported de-identified, aggregate numbers of pregnant people admitted, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, and maternal and newborn deaths. RESULTS There were 1,622 admissions of pregnant people in 12 months in the selected jails. The highest 1-day count of pregnant people at a single jail was 65. The majority of these admissions involved the release of a pregnant person. Of the 224 pregnancies that ended in jail, 144 (64%) were live births, 41 (18%) were miscarriages, 33 (15%) were induced abortions, and four were ectopic (1.8%). One third of the births were cesarean deliveries and 8% were preterm. There were two stillbirths, one newborn death, and no maternal deaths. CONCLUSION About 3% of admissions of females to U.S. jails are of pregnant people; extrapolating study results to national female jail admission rates suggests nearly 55,000 pregnancy admissions in 1 year. It is feasible to track pregnancy statistics about this overlooked group.
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17
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Shin JE, Cho GJ, Bak S, Won SE, Han SW, Bin Lee S, Oh MJ, Kim SJ. Pregnancy and neonatal outcomes of women with disabilities: a nationwide population-based study in South Korea. Sci Rep 2020; 10:9200. [PMID: 32514114 PMCID: PMC7280207 DOI: 10.1038/s41598-020-66181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/15/2020] [Indexed: 11/29/2022] Open
Abstract
We investigated (1) pregnancy and neonatal outcomes in women with and without disabilities, (2) time trends in deliveries, and (3) risks of pregnancy and neonatal complications among women with various disability types and severity. This was a nationwide population-based study merging the database of the Korea National Health Insurance claims, National Health Screening Program for Infants and Children, and Disability Registration System to compare perinatal outcomes in women with and without disabilities. Pregnancy and neonatal outcomes were analyzed during 2007 and 2015, as were time trends of deliveries. Multivariate logistic regression was used to evaluate risk of perinatal outcomes among women with various disability types and severities. Women with disabilities showed higher rates of cesarean section (aOR, 1.73; 95% CI, 1.69–1.77), hypertensive disorders (aOR, 1.74; 95% CI, 1.63–1.86), placenta abruption (aOR, 1.27; 95% CI, 1.12–1.45), placenta previa (aOR, 1.14; 95% CI, 1.05–1.24), stillbirths (aOR, 1.30; 95% CI, 1.17–1.45), preterm births (aOR, 1.67; 95% CI, 1.57–1.78), and LBW (aOR, 1.87; 95% CI, 1.78–1.97) than those without disabilities. From 2007 to 2015, although delivery rate in women with disabilities decreased steeply compared with that in women without disabilities, the rate of cesarean section increased in women with disabilities. Women with intellectual disability and those with vision impairment had the highest number of perinatal complications among women with various types of disabilities. Women with disability had more adverse pregnancy and neonatal outcomes than those without disabilities. Specific disability types & severities are more vulnerable to specific perinatal complications.
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Affiliation(s)
- Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Seongeun Bak
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Eun Won
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Han
- School of Industrial Management Engineering, Korea University, Seoul, Korea
| | - Soo Bin Lee
- School of Industrial Management Engineering, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Sa Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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18
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Dissanayake MV, Darney BG, Caughey AB, Horner-Johnson W. Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States. J Womens Health (Larchmt) 2019; 29:345-352. [PMID: 31750752 DOI: 10.1089/jwh.2019.7880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.
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Affiliation(s)
- Mekhala V Dissanayake
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon.,School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,National Institute of Public Health (INSP), Center for Population Health Research (CISP), Cuernavaca, Mexico
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health & Health University, Portland, Oregon
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Zhang Y, McLain AC, Davis B, McDermott S. Fecundity and Infertility Among Women with Disabilities in the United States. J Womens Health (Larchmt) 2019; 28:934-940. [PMID: 30601101 DOI: 10.1089/jwh.2018.7267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Knowledge of fecundity and infertility in women with a disability (WWD) is limited. This study aims to compare the fecundity and infertility experiences of women with a self-identified disability, in domains of sensory (hearing and vision loss), cognitive (difficulty concentrating, remembering, and making decisions), and physical (difficulty walking or climbing stairs) disabilities, with those without a self-identified disability. Materials and Methods: Cross-sectional survey data from the National Survey of Family Growth (NSFG), 2011-2015, were analyzed. A final analytic sample of 383 women from the NSFG, aged 18-44 years, was included to study the fecundity rates of WWD and women without a disability, using the current duration approach. Results: Fecundity hazard ratios (FHRs) and the proportion of women experiencing infertility after 12 months of actively attempting pregnancy were reported for the comparison group and by each disability type. Women with a self-identified cognitive disability experienced significant decreases in fecundity (FHR = 0.56; 95% confidence interval [CI]: 0.30-0.88) when adjusting for age, education level, parity, living in a metropolitan area, and infertility services. Furthermore, the estimated proportion of infertile women without a disability was 0.38 (95% CI: 0.23-0.62) versus 0.51 (95% CI: 0.34-0.72) for women with a self-identified cognitive disability. Conclusions: Women with a self-identified cognitive disability experienced significant decreases in fecundity.
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Affiliation(s)
- Yanan Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Bryn Davis
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Suzanne McDermott
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
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20
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Auger N, Arbour L, Schnitzer ME, Healy-Profitós J, Nadeau G, Fraser WD. Pregnancy outcomes of women with spina bifida. Disabil Rehabil 2018; 41:1403-1409. [DOI: 10.1080/09638288.2018.1425920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nathalie Auger
- Health Innovation and Evaluation, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau of Information and Studies in Population Health, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Jessica Healy-Profitós
- Health Innovation and Evaluation, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Bureau of Information and Studies in Population Health, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Geneviève Nadeau
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - William D. Fraser
- Department of Obstetrics & Gynecology, Sherbrooke University Hospital Research Centre, Sherbrooke, Canada
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21
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Transcending the counter-normative: Sexual and reproductive health and persons with disability. Disabil Health J 2017; 10:369-370. [PMID: 28395909 DOI: 10.1016/j.dhjo.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 12/22/2022]
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