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Harkins SE, Barcelona V. An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities. J Adv Nurs 2024. [PMID: 38969486 DOI: 10.1111/jan.16304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/17/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024]
Abstract
AIM(S) To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities. DESIGN Discussion paper. METHODS We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health. DATA SOURCES We conducted a systematic review of literature published from 2001 to 2024 in four databases. RESULTS Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes. CONCLUSION The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women. IMPLICATIONS FOR NURSING Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps. IMPACT The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.
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Affiliation(s)
- Sarah E Harkins
- Columbia University School of Nursing, New York, New York, USA
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Camden A, Grandi SM, Lunsky Y, Ray JG, Sharpe I, Lu H, Guttmann A, Tailor L, Vigod S, De Vera MA, Brown HK. Prescription Medication Use in Pregnancy in People with Disabilities: A Population-Based Cohort Study. J Womens Health (Larchmt) 2024. [PMID: 38946624 DOI: 10.1089/jwh.2023.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background: Individuals with disabilities may require specific medications in pregnancy. The prevalence and patterns of medication use, overall and for medications with known teratogenic risks, are largely unknown. Methods: This population-based cohort study in Ontario, Canada, 2004-2021, comprised all recognized pregnancies among individuals eligible for public drug plan coverage. Included were those with a physical (n = 44,136), sensory (n = 13,633), intellectual or developmental (n = 2,446) disability, or multiple disabilities (n = 5,064), compared with those without a disability (n = 299,944). Prescription medication use in pregnancy, overall and by type, was described. Modified Poisson regression generated relative risks (aRR) for the use of medications with known teratogenic risks and use of ≥2 and ≥5 medications concurrently in pregnancy, comparing those with versus without a disability, adjusting for sociodemographic and clinical factors. Results: Medication use in pregnancy was more common in people with intellectual or developmental (82.1%), multiple (80.4%), physical (73.9%), and sensory (71.9%) disabilities, than in those with no known disability (67.4%). Compared with those without a disability (5.7%), teratogenic medication use in pregnancy was especially higher in people with multiple disabilities (14.2%; aRR 2.03, 95% confidence interval [CI]: 1.88-2.20). Furthermore, compared with people without a disability (3.2%), the use of ≥5 medications concurrently was more common in those with multiple disabilities (13.4%; aRR 2.21, 95% CI: 2.02-2.41) and an intellectual or developmental disability (9.3%; aRR 2.13, 95% CI: 1.86-2.45). Interpretation: Among people with disabilities, medication use in pregnancy is prevalent, especially for potentially teratogenic medications and polypharmacy, highlighting the need for preconception counseling/monitoring to reduce medication-related harm in pregnancy.
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Affiliation(s)
- Andi Camden
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- ICES, Toronto, Canada
| | - Sonia M Grandi
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yona Lunsky
- ICES, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Joel G Ray
- ICES, Toronto, Canada
- Department of Obstetrics and Gynaecology, St. Michaels Hospital, Toronto, Canada
| | | | | | - Astrid Guttmann
- ICES, Toronto, Canada
- Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Lauren Tailor
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Department of Psychiatry, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- ICES, Toronto, Canada
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Madlock-Brown C, Lee A, Seltzer J, Solomonides A, Mathews N, Phuong J, Weiskopf N, Adams WG, Lehmann H, Espinoza J. Racial Disparities in Diabetes Care and Outcomes for Patients with Visual Impairment: A Descriptive Analysis of the TriNetX Research Network. RESEARCH SQUARE 2024:rs.3.rs-3901158. [PMID: 38352357 PMCID: PMC10862972 DOI: 10.21203/rs.3.rs-3901158/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background: This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment. Methods: Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified patients with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments. Results: The incidence of diabetes was substantially higher (nearly double) in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.79 for African American, 2.27 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort (0.843). White individuals without visual impairments were more likely to receive two A1c tests, a trend not significant in other racial groups. African Americans with visual impairments had a higher rate of glomerular filtration rate testing. However, White individuals with visual impairments were less likely to undergo GFR testing, indicating a disparity in kidney health monitoring. This pattern of disparity was not observed in the Asian cohort. Conclusions: This study uncovers pronounced disparities in diabetes incidence and management among individuals with visual impairments, particularly among White, Asian, and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.
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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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Hull SC, Chou JC, Yee LM, Yee D, Esserman L. A Truly Pro-Life Position Requires Access to Reproductive Health Care. J Womens Health (Larchmt) 2023; 32:1023-1026. [PMID: 37379465 DOI: 10.1089/jwh.2023.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Affiliation(s)
- Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Program for Biomedical Ethics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Josephine C Chou
- Division of Cardiovascular Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas Yee
- Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Laura Esserman
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
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Plapler PG, Cecatto RB, Socolowski MD, Martins F. Disability prevalent conditions in women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S115. [PMID: 37556634 PMCID: PMC10411700 DOI: 10.1590/1806-9282.2023s115] [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: 02/26/2023] [Accepted: 03/18/2023] [Indexed: 08/11/2023]
Abstract
UNLABELLED Women and men can have the same illnesses, but with different prevalence and reactions to symptoms. OBJECTIVE This study aimed to emphasize that distinct traits between men and women require a different approach for each of them. METHODS PubMed and Google Scholar were searched using the following terms: Disability Evaluations, Women's health, Osteoporosis, Osteoarthritis, and Lymphedema, Pregnancy. RESULTS/CONCLUSION Disease management can go beyond the symptoms, assessing the long-term consequences and possibly the disabilities they can generate, compromising the quality of life of the person, his/her family members, and eventually caregivers.
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Affiliation(s)
- Pérola Grinberg Plapler
- Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina – São Paulo (SP), Brazil
| | - Rebeca Boltes Cecatto
- Universidade de São Paulo, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas, Faculdade de Medicina – São Paulo (SP), Brazil
- Universidade Nove de Julho, Escola de Medicina – São Paulo (SP), Brazil
| | - Mariela Diament Socolowski
- Universidade de São Paulo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina – São Paulo (SP), Brazil
| | - Fernanda Martins
- Universidade de São Paulo, Instituto de Medicina Física e Reabilitação, Hospital das Clínicas, Faculdade de Medicina – São Paulo (SP), Brazil
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Wolfe NK. We Can Do Better: Reproductive Health Counseling for Women with Congenital Heart Disease and Disabilities. J Womens Health (Larchmt) 2023; 32:734-735. [PMID: 36989513 DOI: 10.1089/jwh.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Natasha K Wolfe
- Department of Internal Medicine and Pediatrics, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Testa A, Diaz J, Ganson KT, Jackson DB, Nagata JM. Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System. J Am Dent Assoc 2023; 154:225-234.e7. [PMID: 36681551 DOI: 10.1016/j.adaj.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being. METHODS The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy. RESULTS Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities. CONCLUSIONS Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy. PRACTICAL IMPLICATIONS Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.
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Link D. Laws Are Not Enough. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Smith LD, Valentine A, Moore Simas TA, Parish SL, Levy A, Mitra M. Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2022; 48:12-22. [PMID: 36969147 PMCID: PMC10036077 DOI: 10.3109/13668250.2022.2086110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. Method We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships. Results The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). Conclusions Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.
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Affiliation(s)
- Lauren D. Smith
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester , MA, USA
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Alanna Levy
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Smeltzer SC, Tina Maldonado L, McKeever A, Amorim F, Arcamone A, Nthenge S. Qualitative Descriptive Study of Childbirth Educators' Perspectives on Prenatal Education for Women With Physical Disability. J Obstet Gynecol Neonatal Nurs 2022; 51:302-312. [PMID: 35331670 DOI: 10.1016/j.jogn.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the knowledge, experiences, and perceptions of childbirth educators about providing childbirth education to women with physical disability. DESIGN Qualitative descriptive design. SETTING Telephone interviews. PARTICIPANTS Seventeen childbirth educators. METHODS We used a semistructured interview guide to explore participants' knowledge, experiences, and perceptions of providing childbirth education to women with physical disability. We audio recorded, transcribed, and analyzed the interviews using content analysis. RESULTS We identified four themes: Importance of Childbirth Education for All Women, Inadequate Knowledge About Physical Disability, Willingness to Learn About Physical Disability, and Misconceptions and Assumptions About Women With Physical Disability. CONCLUSION Participants reported little knowledge about the needs of pregnant women with physical disability and limited experience with them in childbirth education classes. They reported eagerness to learn about disability and its effect on pregnancy to help provide meaningful education to women with physical disability. Childbirth educators need to develop and implement innovative approaches to reach women with physical disability, provide information relevant to their needs, and address the misconceptions and assumptions they may have about women with physical disability and pregnancy.
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Gleason JL, Grewal J, Chen Z, Cernich AN, Grantz KL. Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities. JAMA Netw Open 2021; 4:e2138414. [PMID: 34910153 PMCID: PMC8674748 DOI: 10.1001/jamanetworkopen.2021.38414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Women with disabilities have a higher risk of preterm birth, gestational diabetes, preeclampsia, and cesarean delivery; however, their risk of other obstetric interventions, adverse maternal outcomes, and clinical indications for increased cesarean delivery is unclear. OBJECTIVE To evaluate risk of a range of obstetric interventions and adverse maternal outcomes, including severe maternal morbidities (SMM) and mortality, among women with and without disabilities. DESIGN, SETTING, AND PARTICIPANTS The Consortium on Safe Labor was a retrospective cohort that included comprehensive medical chart review for deliveries between January 2002 and January 2008. Data were collected from 12 clinical sites, which included 19 hospitals across the United States. This secondary analysis was conducted in February to July 2021. EXPOSURES Using International Classification of Diseases, Ninth Revision, codes and a validated algorithm to define disability, participants were classified as having physical, intellectual, sensory, or any disability, and compared with women with no documented disability. MAIN OUTCOMES AND MEASURES The relative risk (RR) of 23 obstetric interventions and adverse maternal outcomes, including SMM and mortality, was evaluated. RESULTS Of the 223 385 women in the study, 9206 (4.1%) were Asian or Pacific Islander, 50 235 (22.5%) were Black, 39 039 (17.5%) were Hispanic, and 110 443 (49.4%) were White, with a mean (SD) age of 27.6 (6.2) years. There were 2074 (0.9%) women with disability and 221 311 (99.1%) without. Among women with disabilities, 1733 (83.5%) were physical, 91 (4.4%) were intellectual, and 250 (12.1%) were sensory. Compared with women with no disability, women with disabilities had higher risk of gestational diabetes, placenta previa, premature rupture of membranes, preterm premature rupture of membranes, and postpartum fever as well as maternal death (adjusted relative risk [aRR], 11.19; 95% CI, 2.40-52.19) and individual SMMs: severe preeclampsia/eclampsia (aRR, 2.15; 95% CI, 1.80-2.56), hemorrhage (aRR, 1.27; 95% CI, 1.09-1.49), and fever (aRR, 1.32; 95% CI, 1.03-1.67), with the highest risk observed for thromboembolism (aRR, 6.08; 95% CI, 4.03-9.16), cardiovascular events (aRR, 4.02; 95% CI, 2.87-5.63), and infection (aRR, 2.69; 95% CI, 1.97-3.67). Women with any disability also had higher risk of interventions, including oxytocin augmentation, operative vaginal delivery, and cesarean delivery (aRR, 1.33; 95% CI, 1.25-1.42), with the cesarean indication less likely to be medically indicated (aRR, 0.79; 95% CI, 0.70-0.89). Risk of adverse outcomes and interventions remained consistent across disability categories. CONCLUSIONS AND RELEVANCE In this study, women with physical, intellectual, and sensory disability during pregnancy were at higher risk of adverse outcomes, including a broad range of SMM and maternal mortality.
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Affiliation(s)
- Jessica L. Gleason
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jagteshwar Grewal
- Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Alison N. Cernich
- Office of the Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Katherine L. Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Harris CE, Clark VR, Duma N, Uchida AM, Kowalski A. Re: "The Intersection of Disability and Pregnancy: Risks for Maternal Morbidity and Mortality" by Signore et al. J Womens Health (Larchmt) 2021; 30:1362-1363. [PMID: 34524016 DOI: 10.1089/jwh.2021.0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Varina R Clark
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Narjust Duma
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Amiko M Uchida
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Nguyen TV, King J, Edwards N, Dunne MP. "Under great anxiety": Pregnancy experiences of Vietnamese women with physical disabilities seen through an intersectional lens. Soc Sci Med 2021; 284:114231. [PMID: 34293679 DOI: 10.1016/j.socscimed.2021.114231] [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: 11/28/2020] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is scant research on pregnancy experiences of women with physical disabilities in low and middle-income countries. This qualitative study used an intersectional lens to explore pregnancy experiences of women with physical disabilities in northern Vietnam. Specifically, socio-cultural, economic, and environmental influences were analysed, drawing upon their lived experiences. METHODS Two in-depth interviews were conducted at different time-points in 2018 with women with physical disabilities who had given birth in the previous three years. Twenty-nine women participated in the first interview and 27 in the follow-up interview. The interviews were thematically analysed. RESULTS The women were happy and excited when discovering their pregnancy but they also experienced anxiety, fear, and distress. Their ambivalence related to concerns around having a child with disabilities, their capability to carry a pregnancy, and their mothering abilities. Negative community views of disability were internalised by the women. These socio-culturally constructed beliefs led to lack of confidence in their pregnancy journey. This was exacerbated by inaccessible environments that contributed to increased risk of falls, and women who used wheelchairs experienced particular difficulties. Other powerful influences included poverty, lost income, and costs associated with pregnancy. Single mothers with disabilities experienced additional stigma and discrimination as Vietnamese society judged their pregnancies as socially unacceptable. CONCLUSION This study contributes to knowledge and understanding about women with physical disabilities, specifically how the intersection of gender, disability, socio-economic, and marital status shaped their pregnancy experiences in Vietnam. Multiple challenges were encountered by the women in their pregnancy journey, including negative community views, inaccessible environments, and poverty. The findings highlight the necessity for Vietnamese women with physical disabilities to be actively engaged in talking about their experiences to ensure maternal and child health providers become more sensitive to their pregnancy and motherhood needs.
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Affiliation(s)
- Thi Vinh Nguyen
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia.
| | - Julie King
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia
| | - Niki Edwards
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia
| | - Michael P Dunne
- Institute for Community Health Research, Hue University, Hue, 47000, Viet Nam; Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, 4059, Australia
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15
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Booth EJ, Kitsantas P, Min H, Pollack AZ. Stressful life events and postpartum depressive symptoms among women with disabilities. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211066186. [PMID: 34904463 PMCID: PMC8679014 DOI: 10.1177/17455065211066186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/28/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Although research evidence indicates positive associations between stressful life events and postpartum depression, limited research assessed these associations in women with disabilities. This study examined the effects of stressful life events on postpartum depressive symptoms in women with disabilities. METHODS Data from the 2012-2017 Massachusetts Pregnancy Risk Assessment Monitoring System (n = 8453) were used in this study. Women were asked if they experienced any life stressors (e.g. financial, traumatic, relational, and emotional) during the 12 months prior to giving birth. Disability was measured based on reports of emotional and physical functioning. Descriptive statistics, bivariate, and binary logistic regression analyses were conducted to estimate the effect of stressful life events on postpartum depressive symptoms among women with and without disabilities. RESULTS Findings show that 37.4% of women with disabilities had postpartum depressive symptoms, which was significantly higher than 8.79% of women without disabilities. Stressful life events were reported in 86.6% of women with disabilities, compared to 66.6% for women without disabilities. Prevalence of three or more stressful life events and postpartum depressive symptoms was greater among women with disabilities (50.8% and 62.9%, respectively) than women without disabilities (22.6% and 37.0%, respectively). Women with disabilities experiencing six or more stressful life events were more likely (odds ratio = 3.78, 95% confidence interval = [1.57-9.10]) to report postpartum depressive symptoms, compared to those with no stressful life events. Women with disabilities who experienced relational (odds ratio = 2.36, 95% confidence interval = [1.44-3.87]) and traumatic (odds ratio = 1.75, 95% confidence interval = [1.02-3.00]) life stressors had higher odds for postpartum depressive symptoms relative to those reporting no such life stressors. CONCLUSION Women with disabilities are at an amplified risk for stressful life events and postpartum depressive symptoms. Relational and traumatic stressful life events particularly increase the odds for postpartum depressive symptoms among this group of mothers. Early prenatal and postnatal screening for life stressors and depressive symptoms, coupled with timely referral for appropriate prenatal and postnatal care, are vital to mitigate the harmful effects of depression among mothers with disabilities and the health of their children.
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Affiliation(s)
- Edward J Booth
- Department of Health Administration and
Policy, George Mason University, Fairfax, VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and
Policy, George Mason University, Fairfax, VA, USA
| | - Hua Min
- Department of Health Administration and
Policy, George Mason University, Fairfax, VA, USA
| | - Anna Z Pollack
- Department of Global and Community
Health, George Mason University, Fairfax, VA, USA
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16
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Lu MC, Noursi S. Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States. J Womens Health (Larchmt) 2020; 30:280-284. [PMID: 33216690 PMCID: PMC8020501 DOI: 10.1089/jwh.2020.8877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Maternal mortality in the United States is at an alarming rate. Research can have an important role in addressing maternal mortality, but our current understanding of its causes and prevention remains woefully incomplete. The collection of articles in this volume begin to frame a new research agenda by asking four critical questions. First, what truly makes vulnerable populations vulnerable? Second, how do we prevent pregnancy complications and their long-term sequelae? Third, how can we make maternity care safer for all women? Finally, what can we do about the social, structural, and environmental determinants of maternal health? Answers to these questions can help inform practice, systems, and policy change to reduce and ultimately eradicate maternal deaths in the United States.
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Affiliation(s)
- Michael C Lu
- Berkeley School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Samia Noursi
- Office of Research on Women's Health, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
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