1
|
Deierlein AL, Park C, Patel N, Gagnier R, Thorpe M. Mental health outcomes across the reproductive life course among women with disabilities: a systematic review. Arch Womens Ment Health 2024:10.1007/s00737-024-01506-5. [PMID: 39222078 DOI: 10.1007/s00737-024-01506-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities. RESULTS A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities. CONCLUSIONS Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.
Collapse
Affiliation(s)
| | - Curie Park
- School of Global Public Health, New York University, New York, NY, USA
| | - Nishtha Patel
- School of Global Public Health, New York University, New York, NY, USA
| | - Robin Gagnier
- School of Global Public Health, New York University, New York, NY, USA
| | - Michele Thorpe
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| |
Collapse
|
2
|
Shea L, Sadowsky M, Tao S, Rast J, Schendel D, Chesnokova A, Headen I. Perinatal and Postpartum Health Among People With Intellectual and Developmental Disabilities. JAMA Netw Open 2024; 7:e2428067. [PMID: 39145975 PMCID: PMC11327882 DOI: 10.1001/jamanetworkopen.2024.28067] [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] [Indexed: 08/16/2024] Open
Abstract
Importance Small, geographically limited studies report that people with intellectual and developmental disabilities (IDD) have increased risk for serious pregnancy-related and birth-related challenges, including preeclampsia, preterm birth, and increased anxiety and depression, than their peers. United States-based population-level data among people with IDD are lacking. Objectives To identify perinatal and postpartum outcomes among a national, longitudinal sample of people with IDD enrolled in public health insurance, compare subgroups of people with IDD, and compare outcomes among people with IDD with those of peers without IDD. Design, Setting, and Participants This retrospective cohort study used national Medicaid claims from January 1, 2008, to December 31, 2019, for 55 440 birthing people with IDD and a random sample of 438 557 birthing people without IDD. Medicaid funds almost half of all births and is the largest behavioral health insurer in the US, covering a robust array of services for people with IDD. Statistical analysis was performed from July 2023 to June 2024. Exposure People who had a documented birth in Medicaid during the study years. Main Outcome and Measures Perinatal outcomes were compared across groups using univariate and multivariate logistic regression. The probability of postpartum anxiety and depression was estimated using Kaplan-Meier and Cox proportional hazards regression. Results The study sample included 55 440 birthing people with IDD (including 41 854 with intellectual disabilities [ID] and 13 586 with autism; mean [SD] age at first delivery, 24.9 [6.7] years) and a random sample of 438 557 birthing people without IDD (mean [SD] age at first delivery, 26.4 [6.3] years). People with IDD were younger at first observed delivery, had a lower prevalence of live births (66.6% vs 76.7%), and higher rates of obstetric conditions (gestational diabetes, 10.3% vs 9.9%; gestational hypertension, 8.7% vs 6.1%; preeclampsia, 6.1% vs 4.4%) and co-occurring physical conditions (heart failure, 1.4% vs 0.4%; hyperlipidemia, 5.3% vs 1.7%; ischemic heart disease, 1.5% vs 0.4%; obesity, 16.3% vs 7.4%) and mental health conditions (anxiety disorders, 27.9% vs 6.5%; depressive disorders, 32.1% vs 7.5%; posttraumatic stress disorder, 9.5% vs 1.2%) than people without IDD. The probability of postpartum anxiety (adjusted hazard ratio [AHR], 3.2 [95% CI, 2.9-3.4]) and postpartum depression (AHR, 2.4 [95% CI, 2.3-2.6]) was significantly higher among autistic people compared with people with ID only and people without IDD. Conclusions and Relevance In this retrospective cohort study, people with IDD had a younger mean age at first delivery, had lower prevalence of live births, and had poor obstetric, mental health, and medical outcomes compared with people without IDD, pointing toward a need for clinician training and timely delivery of maternal health care. Results highlight needed reproductive health education, increasing clinician knowledge, and expanding Medicaid to ensure access to care for people with IDD.
Collapse
Affiliation(s)
- Lindsay Shea
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Molly Sadowsky
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Sha Tao
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Jessica Rast
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Schendel
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Arina Chesnokova
- Division of Academic Specialists, University of Pennsylvania, Philadelphia
| | - Irene Headen
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
Rudra S, McManus S, Hassiotis A, Ali A. Mental health and service use of parents with and without borderline intellectual functioning. Psychol Med 2024; 54:1294-1308. [PMID: 37877259 DOI: 10.1017/s0033291723003136] [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] [Indexed: 10/26/2023]
Abstract
BACKGROUND People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF. METHODS A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment. RESULTS Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems. CONCLUSIONS Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.
Collapse
Affiliation(s)
| | - Sally McManus
- City University and NatCen Associate; NatCen Social Research, London, UK
| | | | - Afia Ali
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK
| |
Collapse
|
4
|
Powell RM, Albert SM, Nthenge S, Mitra M. Family Caregivers' Attitudes and Perspectives About the Sexual and Reproductive Health of Women With Intellectual and Developmental Disabilities: An Online Survey. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:135-150. [PMID: 38411243 DOI: 10.1352/1944-7558-129.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/11/2023] [Indexed: 02/28/2024]
Abstract
Although sexual and reproductive health is critically important for women with intellectual and developmental disabilities (IDD), there is limited research elucidating the role of family caregivers in assisting women with IDD access sexual and reproductive health services and information. Understanding the family caregivers' attitudes and perspectives is essential to improving access to sexual and reproductive health services and information for women with IDD. A cross-sectional online survey of family caregivers of women with IDD was administered between June and October 2018. Quantitative analysis was conducted for closed-ended responses, and qualitative analysis was conducted for open-ended responses. The analytic sample included 132 family caregivers. Most participants were parents and reported being closely involved in their family member's access to sexual and reproductive health services and information. Although most participants expressed that sexual and reproductive health services and information are essential for women with IDD, qualitative analysis of participants' open-ended responses revealed both supportive and restrictive attitudes and perspectives on sexual and reproductive health services and information for women with IDD. Supportive attitudes and perspectives included (1) "knowledge is power;" (2) supported decision-making; and (3) protection against sexual abuse. Restrictive attitudes and perspectives included (1) dependent on the individual; (2) lack of autonomy; and (3) placing responsibility on disability. Greater attention from policymakers and practitioners to systems-level changes, including universal and accessible sexual education for women with IDD, supported decision-making, and sexual abuse prevention measures, are urgently needed.
Collapse
Affiliation(s)
- Robyn M Powell
- Robyn M. Powell, University of Oklahoma College of Law and The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
| | - Sasha M Albert
- Sasha M. Albert, The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
| | | | - Monika Mitra
- Monika Mitra, The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
| |
Collapse
|
5
|
Mitchell KA, Haddock AJ, Husainy H, Walter LA, Rajapreyar I, Wingate M, Smith CH, Tita A, Sinkey R. Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality. Am J Perinatol 2023; 40:489-507. [PMID: 34327686 PMCID: PMC10961102 DOI: 10.1055/s-0041-1732455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. STUDY DESIGN We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. RESULTS A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. CONCLUSION As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126). KEY POINTS · Up to 12% of postpartum women seek care in the ED.. · One-third of maternal deaths occur postpartum.. · Maternal mortality reduction efforts should include ED stakeholders..
Collapse
Affiliation(s)
- Kellie A. Mitchell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Alison J. Haddock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Lauren A. Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha Wingate
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H. Smith
- Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Rachel Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| |
Collapse
|
6
|
Brown HK, Vigod SN, Fung K, Chen S, Guttmann A, Havercamp SM, Parish SL, Ray JG, Lunsky Y. Perinatal mental illness among women with disabilities: a population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2217-2228. [PMID: 35939075 PMCID: PMC9722243 DOI: 10.1007/s00127-022-02347-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the risk of perinatal mental illness, including new-onset disorders and recurrent or ongoing use of mental health care, comparing women with physical, sensory, intellectual/developmental, and multiple disabilities to those without a disability. METHODS From all women aged 15-49 years with a singleton birth in Ontario, Canada (2003-2018), those with physical (n = 144,972), sensory (n = 45,249), intellectual/developmental (n = 2,227), and ≥ 2 of these disabilities ("multiple disabilities"; n = 8,883), were compared to 1,601,363 without a disability on risk of healthcare system contact for mental illness from conception to 365 days postpartum. The cohort was stratified into: (1) no pre-pregnancy mental illness (to identify new-onset illness), (2) distal mental illness (> 2 years pre-pregnancy, to identify recurrent illness), and (3) recent mental illness (0-2 years pre-pregnancy, to identify ongoing contact). Modified Poisson regression generated relative risks (aRR), adjusted for age, parity, income quintile, and rural residence. RESULTS About 14.7, 26.5, and 56.6% of women with no disabilities had new-onset, recurrent, and ongoing contact for mental illness, respectively, perinatally. Risks were elevated across disability groups for new-onset (physical: aRR 1.18, 95% CI 1.16-1.20; sensory: 1.11, 1.08-1.15; intellectual/developmental: 1.38, 1.17-1.62; multiple: 1.24, 1.15-1.33), recurrent (physical: 1.10, 1.08-1.12; sensory 1.06, 1.02-1.09; intellectual/developmental: 1.24, 1.11-1.37; multiple: 1.16, 1.09-1.23), and ongoing contact (physical: 1.09, 1.08-1.10; sensory: 1.08, 1.06-1.10; intellectual/developmental: 1.31, 1.26-1.37; multiple: 1.20, 1.16-1.23). CONCLUSION The heightened use of new, recurrent, and ongoing mental health care across disability groups in the perinatal period suggests that adapted screening and intervention approaches are critical to optimize perinatal mental health in this population.
Collapse
Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Kinwah Fung
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Simon Chen
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
| | - Astrid Guttmann
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
- Hospital for Sick Children, Toronto, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Susan M Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, USA
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Joel G Ray
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES (Formerly the Institute for Clinical Evaluative Sciences), Toronto, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y. Neonatal Outcomes of Mothers With a Disability. Pediatrics 2022; 150:e2021055318. [PMID: 35934737 PMCID: PMC9694113 DOI: 10.1542/peds.2021-055318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the risk of neonatal complications among women with a disability. METHODS This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics. RESULTS Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42). CONCLUSIONS There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.
Collapse
Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
9
|
York J, Wechuli Y, Karbach U. Emergency Medical Care of People with Intellectual Disabilities: A Scoping Review. Open Access Emerg Med 2022; 14:441-456. [PMID: 35983306 PMCID: PMC9381009 DOI: 10.2147/oaem.s361676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The paper intends to do a scoping review of people with intellectual disabilities in emergency care where this group seems to face access barriers and discrimination. It analyses the conceptual and methodological framework for studies examining the former. Methods A scoping review is conducted. The studies' quality is assessed via a checklist developed by the authors drawing on a compilation of common assessment tools for study quality. Results Fourteen quantitative studies fulfil the inclusion criteria for further analysis. Summary measures are extracted. Results are synthesized with Andersen's Behavioral Model of Health Service Use. Studies employ a combination of variables attributable to different aspects of population characteristics and health behavior. Conclusion Most studies seek to quantify or predict emergency care overuse by people with intellectual disabilities. Future studies should also take patients' poor health or treatment outcomes and their perspectives into account.
Collapse
Affiliation(s)
- Jana York
- Faculty of Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
| | - Yvonne Wechuli
- Faculty of Human Sciences, University of Kassel, Kassel, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| |
Collapse
|
10
|
Brown HK, Tint A, Heifetz M, Chacra MA, Bluestein D, Vigod S, Lunsky Y. Barriers and requirements for parenting supports and mental health care among mothers with intellectual disabilities: Health and social service-provider perspectives. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104237. [PMID: 35487050 DOI: 10.1016/j.ridd.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Mothers with intellectual disability (ID) experience high rates of mental illness, but these needs are not adequately addressed. AIMS We examined health and social service-provider perceptions of barriers to parenting and mental health care among mothers with ID and strategies for building good practice capacity. METHODS AND PROCEDURES In this qualitative study in Ontario, Canada, we interviewed 13 service-providers working with mothers with ID about their experiences supporting parenting and mental health in mothers with ID, including barriers to services and strategies for building good practice capacity. Data were analyzed via inductive, semantic-level thematic analysis. OUTCOMES AND RESULTS Perceived barriers to care provision were the vulnerable social context of women with ID, distrust of "the system" by women with ID, and siloed services. Increased training of service-providers, making accommodations in existing services, and building a community of support for women with ID were offered as strategies for good practice capacity. CONCLUSIONS AND IMPLICATIONS Efforts to improve mental health among mothers with ID should focus on improving service-provider capacity and accommodations in existing services, and enhancing coordination of care. WHAT THIS PAPER ADDS?: Mothers with intellectual disability (ID) experience high rates of mental illness, but supports for mothers with ID typically focus on parenting skills, and women's mental health care services do not consider the unique needs of those with ID. Health and social service-providers have reported inadequate training, fragmented services, high caseloads, and lack of practical supports as barriers to providing quality care to mothers with ID. However, no studies have examined service-providers' perceptions of needs related specifically to parenting and mental health among mothers with ID. This study provides new information on barriers to parenting and mental health care among mothers with ID and strategies for good practice capacity, from the perspectives of service-providers. Perceived barriers to care provision include social determinants of health, a distrust of "the system" by women with ID, and siloed services. Providers recommended that providing better training, including accommodations in existing services, and building a community of support could be beneficial to improving practice capacity in the context of mental health care and parenting supports. These factors need to be addressed to improve mental health among mothers with ID.
Collapse
Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada; Dalla Lana School of Public Health, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marina Heifetz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
11
|
Brown HK, Chen S, Vigod SN, Guttmann A, Havercamp SM, Parish SL, Tarasoff LA, Lunsky Y. A population-based analysis of postpartum acute care use among women with disabilities. Am J Obstet Gynecol MFM 2022; 4:100607. [PMID: 35248782 PMCID: PMC9703340 DOI: 10.1016/j.ajogmf.2022.100607] [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: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Disability is common in reproductive-aged women, and as many as 1 in 8 pregnancies occur in women with a disability. Women with disabilities experience significant social and health disparities, and are at greater risk than their nondisabled counterparts for perinatal complications. Yet, few studies have examined their postpartum acute care use. OBJECTIVE To examine risks of postpartum emergency department visits and hospital admissions among women with and without physical, sensory, and intellectual/developmental disabilities. STUDY DESIGN In this population-based study in Ontario, Canada, women with a singleton obstetrical delivery from 2003 to 2019 were classified into those with physical (n=155,500), sensory (n=49,338), intellectual/developmental (n=2650), and multiple disabilities (≥2 disabilities; n=9904), and women without disabilities (n=1,701,574). Primary outcomes were emergency department visits and hospital admissions 0 to 365 days after index delivery hospital discharge. Secondary outcomes were emergency department visits and hospital admissions by primary diagnosis (medical, psychiatric) and by timing (0-7, 8-42, 43-365 days postpartum). Adjusted relative risks comparing each disability group to those without disabilities were adjusted for age; parity; income quintile; rurality; immigrant/refugee status; prepregnancy chronic medical conditions, mental illness, and substance use disorders; and prenatal care provider type. RESULTS Any postpartum emergency department visit occurred in 23.5% of women without a disability, with risks elevated in women with physical (32.9%; adjusted relative risk, 1.27; 95% confidence interval, 1.26-1.28), sensory (30.0%; adjusted relative risk, 1.16; 95% confidence interval, 1.15-1.18), intellectual/developmental (48.8%; adjusted relative risk, 1.38; 95% confidence interval, 1.33-1.44), and multiple disabilities (42.0%; adjusted relative risk, 1.44; 95% confidence interval, 1.41-1.48) compared with women without disabilities. Similarly, any postpartum hospital admission occurred in 3.0% of women without a disability, with elevated risks in women with physical (4.8%; adjusted relative risk, 1.37; 95% confidence interval, 1.34-1.40), sensory (4.0%; adjusted relative risk, 1.19; 95% confidence interval, 1.14-1.24), intellectual/developmental (9.6%; adjusted relative risk, 1.96; 95% confidence interval, 1.73-2.21), and multiple disabilities (7.3%; adjusted relative risk, 1.77; 95% confidence interval, 1.64-1.90). Results were consistent by primary diagnosis and timing in the postpartum period. CONCLUSION Women with disabilities have elevated risk of emergency department visits and hospital admissions in the postpartum period, indicating greater postpartum morbidity, which requires attention through enhanced and extended follow-up across the postpartum period.
Collapse
Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky).
| | - Simon Chen
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky)
| | - Simone N Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Women's College Research Institute, Women's College Hospital, Toronto, Canada (Drs Brown and Vigod); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky)
| | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (Drs Brown, Vigod, and Guttmann); Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Hospital for Sick Children, Toronto, Canada (Dr Guttmann); Department of Pediatrics, University of Toronto, Toronto, Canada (Dr Guttmann)
| | - Susan M Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, OH (Dr Havercamp)
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA (Dr Parish)
| | - Lesley A Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada (Drs Brown and Tarasoff); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, Canada (Drs Brown, Chen, Vigod, Guttmann, and Lunsky); Department of Psychiatry, University of Toronto, Toronto, Canada (Drs Vigod and Lunsky); Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Canada (Drs Tarasoff and Lunsky)
| |
Collapse
|
12
|
Amir N, Smith L, Valentine AM, Mitra M, Parish SL, Moore Simas TA. Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101262. [PMID: 35031269 PMCID: PMC8983509 DOI: 10.1016/j.dhjo.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/27/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs. OBJECTIVE The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content. METHODS This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships. RESULTS Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs. CONCLUSION Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs. LEVEL OF EVIDENCE VI.
Collapse
Affiliation(s)
- Nili Amir
- University of Connecticut Medical School, Department of Obstetrics and Gynecology, 200 Academic Way, Farmington, CT 06032, USA; University of Masachusetts Chan Medical School, 55 Lake Ave North Worcester, MA 01605, USA.
| | - Lauren Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA
| | - Susan L Parish
- Virginia Commonwealth University, College of Health Professions, 900 E. Leigh Street, Box 980233 Richmond, VA 23298, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School/UMass Memorial Health Care Department of Obstetrics and Gynecology, Pediatrics, Psychiatry, and Population and Quantitative Health Sciences Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA 01605, USA
| |
Collapse
|
13
|
Amir N, Mitra M, Leung K, Moore Simas TA. Complications following hysterectomy in women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101213. [PMID: 34531173 DOI: 10.1016/j.dhjo.2021.101213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD). OBJECTIVE The objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy. METHODS The National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables. RESULTS Of eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18-11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10-38.36). CONCLUSIONS Women with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.
Collapse
Affiliation(s)
- Nili Amir
- UConn Health, Department of Obstetrics and Gynecology, 263 Farmington Avenue Farmington, CT 06030, USA; University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management Brandeis University, 415 South Street Waltham, MA, USA
| | - Katherine Leung
- University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA; UMass Memorial Health Department of Obstetrics and Gynecology Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA, 01605, USA
| |
Collapse
|
14
|
Clements KM, Mitra M, Zhang J, Parish SL. Postpartum Health Care Among Women With Intellectual and Developmental Disabilities. Am J Prev Med 2020; 59:437-444. [PMID: 32605865 PMCID: PMC8204383 DOI: 10.1016/j.amepre.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Postpartum health care among women with intellectual and developmental disabilities has not been well studied. This study uses administrative claims to compare postpartum outpatient visits among women with and without intellectual and developmental disabilities. METHODS Massachusetts All Payers Claims Database 2012-2015 was used to identify women with intellectual and developmental disabilities and a live birth during 2012-2014, matched by infant birth year to 3 women without intellectual and developmental disabilities. Women were followed up for 1 year after delivery. Analyses were conducted in 2019. Poisson regression compared guideline-concordant postpartum and other outpatient visits during the early (21-56 days after delivery) and late (57-365 days after delivery) periods. Types of nonpostpartum care visits were examined. RESULTS Overall, 962 and 2,886 women with and without intellectual and developmental disabilities, respectively, comprised the sample. Among women with intellectual and developmental disabilities, 23.9% had a postpartum visit in the early and 33.3% in the late postpartum periods, compared with 25.2% and 32.1% of women without intellectual and developmental disabilities who had visits in the early and late postpartum periods, respectively (p=0.49, 0.59). Women with intellectual and developmental disabilities were more likely to have other outpatient visits than those without intellectual and developmental disabilities, both in the early (63.1% vs 40.3%, adjusted RR=1.42, 95% CI=1.28, 1.58, p<0.001) and late (94.2% vs 82.3%, RR=1.11, 95% CI=1.08, 1.14, p=0.008) postpartum periods. Ancillary services, home health services, and alcohol/drug-related visits were much more common among women with intellectual and developmental disabilities. CONCLUSIONS Women with intellectual and developmental disabilities are equally likely to receive guideline-concordant postpartum visits and more likely to have other outpatient visits than other women. Further research is needed to evaluate visit quality and identify best practices to support mothers with intellectual and developmental disabilities during the postpartum period.
Collapse
Affiliation(s)
- Karen M Clements
- Commonwealth Medicine Division, University of Massachusetts Medical School, Shrewsbury, Massachusetts.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jianying Zhang
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
15
|
Recent Trends and Future Directions in Research Regarding Parents with Intellectual and Developmental Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 7:173-181. [PMID: 32837826 PMCID: PMC7324308 DOI: 10.1007/s40474-020-00204-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose of Review This report updates research on parents with IDD and their children published since 2014. Recent Findings Since 2014, a plethora of studies using large administrative databases in different countries support a contextual approach to understand why parents with IDD and their children may have worse outcomes than other families. In most studies, increased risk of ill health in women with IDD and health and developmental problems in their children were fully or partially accounted for by socioeconomic and psychosocial hardships. New research has found that pregnant women with IDD tend to have risk factors for pregnancy, birth, and postpartum complications that may contribute to adverse child outcomes. Intervention research is gradually becoming more contextualized. Summary More studies are needed on multicultural aspects of parenting, programs that could help parents with IDD overcome social and health disadvantages, comprehensive and coordinated service models that start during pregnancy, innovative parent support arrangements, parenting education for teens and young adults with IDD, use of technology, and dissemination and implementation of evidence-based programs.
Collapse
|
16
|
Weissmann-Brenner A, Heusler I, Manteka R, Dulitzky M, Baum M. Postpartum visits in the gynecological emergency room: How can we improve? BMC Pregnancy Childbirth 2020; 20:278. [PMID: 32381028 PMCID: PMC7204226 DOI: 10.1186/s12884-020-02927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background The attendance to the gynecological-emergency-room (GER) of women only a few weeks following previous discharge after birth comprises a medical as well as social problem. The objective of the study was to characterize the postpartum women that attended the GER, and depict the leading etiologies and risk-factors that lead them to attend the GER, and to examine correlations between their medical findings at discharge and the reasons for their attendance to the hospital. Methods All women that attended the GER between 01/01/2016 and 30/09/2016 during 6 weeks after birth were included. The variables assessed were: medical history, mode of birth, maternal complications of birth, diagnosis at the GER, treatment received and readmission. Results There were 446 visits of 413 women (5.6% of all deliveries). Most were generally healthy after their first normal vaginal birth with no complications during or following birth. 38.7% had a cesarean birth (p < 0.001). The most common causes of the visits were fever (30.3%), problems in episiotomy or surgical scar (26.6%) and abdominal pain (25.7%). Women with hypertensive disorders during birth had significantly more hypertensive problems in the GER. Diabetic women suffered statistically more from hypertensive disorder in the GER. 33.2% were examined and found healthy. Seventy-two women (1% of all deliveries) were hospitalized, most of them due to infection. Only 7.5% were referred to the GER due to bleeding. Conclusions Postpartum women are at risk of morbidities, especially following cesarean sections and in women with hypertensive disorders of during pregnancy. Scheduled visits to high-risk women to attend outpatient clinic sooner are recommended.
Collapse
Affiliation(s)
- Alina Weissmann-Brenner
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ishai Heusler
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renana Manteka
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Dulitzky
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha Baum
- Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:27.e1-27.e32. [PMID: 31306650 DOI: 10.1016/j.ajog.2019.07.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications. OBJECTIVE A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications. STUDY DESIGN Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies. RESULTS The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation. CONCLUSION Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.
Collapse
|
18
|
Barger MK. Current Resources for Evidence-Based Practice, November/December 2019. J Midwifery Womens Health 2019; 64:775-781. [PMID: 31691482 DOI: 10.1111/jmwh.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, San Diego, California
| |
Collapse
|
19
|
Heifetz M, Brown HK, Chacra MA, Tint A, Vigod S, Bluestein D, Lunsky Y. Mental health challenges and resilience among mothers with intellectual and developmental disabilities. Disabil Health J 2019; 12:602-607. [PMID: 31235446 DOI: 10.1016/j.dhjo.2019.06.006] [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] [Received: 10/25/2018] [Revised: 05/20/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mothers with intellectual and developmental disabilities (IDD) frequently experience mental health problems. Yet, they are excluded from broader women's mental health efforts, and few services exist to support their unique mental health needs. OBJECTIVES Our objective was to identify key risk, protective, and resilience factors that affect mental health among mothers with IDD. METHODS We interviewed mothers with IDD on: (1) a quantitative measure to assess demographics and depressive symptoms and (2) qualitative focus groups on parenting and mental health (analyzed through thematic analysis). There were three focus groups, for a total sample of 12 mothers with IDD. RESULTS The 12 women in the sample had a total of 28 children, with a mean age of 11.3 years (SD = 9.9). The mean depressive symptom score in the sample was 13.8 (SD = 5.5), with 7 women scoring above the cut-off for clinically significant symptoms. Nine thematic categories were identified, organized into risks, protective factors, and resilience factors. Risks were parenting stress, life stressors, feelings of powerlessness with the child welfare system, and feeling judged. Protective factors were formal and informal supports. Resilience factors were motherhood enjoyment, having a good family life, and wishing to be independent. CONCLUSIONS Efforts to improve mental health among mothers with IDD should minimize risks that undermine adaptive capabilities and promote resilience to restore efficacy of protective systems. Better training of service-providers working with individuals with IDD, using strength-based approaches and developing alternative, autonomy-building sources of support in the form of peer support groups is recommended.
Collapse
Affiliation(s)
- Marina Heifetz
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Megan Abou Chacra
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Surrey Place Centre, Toronto, Ontario, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
20
|
Mitra M, Akobirshoev I, Parish SL, Valentine A, Clements KM, Moore Simas TA. Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study. J Epidemiol Community Health 2019; 73:557-563. [DOI: 10.1136/jech-2018-211589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/03/2022]
Abstract
BackgroundAn emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.MethodsWe analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.ResultsWe identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.ConclusionThese findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.
Collapse
|
21
|
Mitra M, Parish SL, Akobirshoev I, Rosenthal E, Moore Simas TA. Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study. Matern Child Health J 2018; 22:1492-1501. [PMID: 29948759 PMCID: PMC6150791 DOI: 10.1007/s10995-018-2546-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002-2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1-42, 43-90, and 1-365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1-42, 43-90, and 91-365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.
Collapse
Affiliation(s)
- Monika Mitra
- The Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02453, USA.
| | - Susan L Parish
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Ilhom Akobirshoev
- The Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Mailstop 035, Waltham, MA, 02453, USA
| | - Eliana Rosenthal
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA, 01605, USA
| |
Collapse
|
22
|
Mitra M, Parish SL, Clements KM, Zhang J, Simas TAM. Antenatal Hospitalization Among U.S. Women With Intellectual and Developmental Disabilities: A Retrospective Cohort Study. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:399-411. [PMID: 30198766 PMCID: PMC9014374 DOI: 10.1352/1944-7558-123.5.399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This population-based retrospective cohort study examines the prevalence of hospital utilization during pregnancy and the primary reason for antenatal hospital utilization among women with intellectual and developmental disabilities (IDD). Massachusetts residents with in-state deliveries that were ≥ 20 weeks gestational age were included via data from the 2002-2009 Massachusetts Pregnancy to Early Life Longitudinal Data System. Among women with IDD, 54.8% had at least one emergency department (ED) visit during pregnancy, compared to 23% of women without IDD. Women with IDD were more likely to have an antenatal ED visit, observational stays, and non-delivery hospital stays. This study highlights the need for further understanding of the health care needs of women with IDD during pregnancy.
Collapse
|
23
|
Mitra M. Postpartum Health of Women with Intellectual and Developmental Disabilities: A Call to Action. J Womens Health (Larchmt) 2017; 26:303-304. [PMID: 28355095 DOI: 10.1089/jwh.2017.6382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| |
Collapse
|