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Lindblad I, Landgren V, Gillberg C, Fernell E. Children born to parents with mild intellectual disability: Register-based follow-up of psychiatric and neurodevelopmental diagnoses and out-of-home placements. Acta Paediatr 2024; 113:1637-1643. [PMID: 38517072 DOI: 10.1111/apa.17218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
AIM Study the outcomes in terms of registered neurodevelopmental diagnoses and out-of-home placements in children whose parents had been diagnosed with mild intellectual disability (ID) in childhood. METHODS The study groups consist of (1) a population-based sample of 78 individuals, born in 1979-1985, meeting criteria for mild ID during childhood, and (2) their 88 children. From national registers, data on outcomes were retrieved in 2020 regarding psychosocial and psychiatric outcomes for the adults, and neurodevelopmental diagnoses and out-of-home placements for the children. RESULTS Of the 78 adults with mild ID, 31 were parents of 88 children, aged 0-21 . The age-adjusted prevalence of neurodevelopmental disorders among the children was 67%. Of the 27 children aged between 13 and 21 years at follow-up, 16 had at least one registered neurodevelopmental diagnosis; 11 had ADHD and 7 had ID. Nine of these 27 children had experienced out of home placement. CONCLUSION Children of parents with mild ID are at high risk of neurodevelopmental disorders, in particular ADHD and ID, and out-of-home placements. Our findings indicate that individuals with mild ID who become parents routinely should be offered individually tailored parent support and their children offered assessment regard neurodevelopmental disorders.
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Affiliation(s)
- I Lindblad
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - V Landgren
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - E Fernell
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
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Zijlstra A, Sterenborg T, van Nieuwenhuijzen M, de Castro BO. Expectant parents with intellectual disabilities in child protection: Risk factors for child safety. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13230. [PMID: 38577739 DOI: 10.1111/jar.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Newborns of parents with intellectual disabilities face higher risks in their environment for child unsafety, despite parents' good intentions. To help parents prevent unsafe circumstances, a good understanding of the risk factors faced by these parents is needed. METHODS This casefile study examined (1) which risk factors were present for expectant parents with intellectual disabilities in child protection, (2) which domains of risk factors, and (3) whether a cumulation of risk factors was related to child safety. RESULTS Expectant parents with intellectual disabilities in child protection before the child was born often experienced a cumulation of risk factors. Child, family, and care factors best predicted child safety. A cumulation of risk factors over multiple life domains increased the risks for child unsafety. CONCLUSIONS To reduce the risks of unsafe parenting conditions for newborns, preventive interventions for expectant parents with intellectual disabilities should address their needs from an ecological perspective.
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Affiliation(s)
- Annick Zijlstra
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessel Sterenborg
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Expect Jeugd, Partners Voor Jeugd, Amsterdam, The Netherlands
| | - Maroesjka van Nieuwenhuijzen
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Expect Jeugd, Partners Voor Jeugd, Amsterdam, The Netherlands
| | - Bram O de Castro
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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3
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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.
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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
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Grzywacz E, Brzuchalski B, Śmiarowska M, Malinowski D, Machoy-Mokrzyńska A, Białecka MA. Significance of Selected Environmental and Biological Factors on the Risk of FASD in Women Who Drink Alcohol during Pregnancy. J Clin Med 2023; 12:6185. [PMID: 37834828 PMCID: PMC10573427 DOI: 10.3390/jcm12196185] [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: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Prenatal alcohol exposure (PAE), which refers to alcohol consumption by pregnant women, is associated with the risk of numerous severe complications during fetal development. The State Agency for Alcohol Problem Solving reports that the incidence of fetal alcohol spectrum disorder (FASD) in Poland's general population is over 1.7%, and the incidence of fetal alcohol syndrome (FAS) is estimated at more than 0.5%. This study aimed to evaluate the significance of alcohol exposure and focused on the pattern of alcohol intoxication exhibited by the mother during pregnancy and other environmental factors of the maternal environment contributing to the development of FASD. The study covered 554 subjects, including 251 mothers and 303 children (213 girls and 90 boys). The mother's drinking problem was determined based on the information obtained from the case history. All children qualified for the study fulfilled the h-PAE (high alcohol exposure) criteria during their fetal life. The clinical diagnosis of FAS and pFAS (occurrence of morphological symptoms of fetal alcohol syndrome) was made using a four-digit diagnostic questionnaire validated in the Polish version of the Washington Questionnaire for the assessment of the spectrum of alcohol-related neurodevelopmental disorders or alcohol-related cognitive impairment (ARND/C). Statistical analysis of the obtained research results was developed using statistical software-STATISTICA PL, version 13.1 (StatSoft, Inc., Szczecin, Poland 2016, STATISTICA-data analysis software system, version 13.1). The most destructive drinking behaviors are compulsive intoxication (BD, binge drinking) during the first 6 weeks of pregnancy and chronic addiction throughout its duration (CHD, chronic drinking). Chronic alcohol intoxication (CHD) leads to a poorer nutritional status in mothers, which is reflected in a lower body mass index (BMI) (<18 kg/m2).
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Affiliation(s)
- Elżbieta Grzywacz
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Bogusław Brzuchalski
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Małgorzata Śmiarowska
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Damian Malinowski
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland;
| | - Monika Anna Białecka
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Aleja Powstanców Wielkopolskich 72 St., 70-111 Szczecin, Poland; (E.G.); (B.B.); (M.Ś.); (M.A.B.)
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Höglund B, Janeslätt G, Arvidsson P, Randell E. Efficacy of a school-based intervention to influence attitudes about future parenting among Swedish youth with intellectual disability: An RCT study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1000-1012. [PMID: 37082781 DOI: 10.1111/jar.13109] [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: 07/06/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The study aim was to investigate the efficacy of an intervention designed to provide a basis for informed choices about future parenthood to special upper secondary school students with intellectual disabilities. METHODS A randomised trial with a waiting list control group was used. In total, 108 special upper secondary school students with mild or moderate intellectual disabilities, age 16-21 years, provided informed consent and participated. The intervention included education using the Parenting Toolkit and a Real Care Baby simulator. The analyses included 91 students (intervention group n = 46, 24F/22M; control group n = 45, 26F/19M). RESULTS The result showed that intervention group changed their attitudes to future parenting, from 'do not know' to 'know', significantly more than control group. The intervention increased knowledge levels in the intervention group. CONCLUSIONS The intervention group showed increased ability to make informed choices and decisions about parenthood.
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Affiliation(s)
- Berit Höglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gunnel Janeslätt
- Department of Public Health and Caring Sciences, SUF Resource Centre, Region Uppsala, Centre for Clinical Research in Dalarna, Uppsala University, Falun, Sweden
| | - Patrik Arvidsson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
- School of Health and Welfare, Disability Research, Jonkoping University, Jonkoping, Sweden
| | - Eva Randell
- Department of Social Work, Uppsala University, Uppsala, Sweden
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Pérez-Curiel P, Vicente E, Morán ML, Gómez LE. The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1587. [PMID: 36674341 PMCID: PMC9864803 DOI: 10.3390/ijerph20021587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 05/31/2023]
Abstract
Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.
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Affiliation(s)
- Patricia Pérez-Curiel
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - Eva Vicente
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - M. Lucía Morán
- Department of Education, University of Cantabria, Av./de los Castros, 52, 39005 Santander, Spain
| | - Laura E. Gómez
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
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Rubenstein E, Ehrenthal DB, Mallinson DC, Bishop L, Kuo HH, Durkin MS. Birth outcomes affecting infants of mothers with intellectual and developmental disabilities. Paediatr Perinat Epidemiol 2021; 35:706-716. [PMID: 33956997 PMCID: PMC8545714 DOI: 10.1111/ppe.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/17/2021] [Accepted: 02/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) face increased risk of adverse maternal pregnancy outcomes, yet less is known about infant outcomes. OBJECTIVES To examine birth outcomes of infants born to mothers with IDD and assess associations with demographics and IDD-type. METHODS We used data from the Big Data for Little Kids project, which links Wisconsin birth records to Medicaid claims for live births covered by Medicaid from 2007 to 2016. We identified IDD using maternal prepregnancy Medicaid claims and ran Poisson regression (with a log link function) with robust variance clustered by mother to compare prevalence of outcomes between singleton births with and without mothers with IDD. We adjusted the associations for demographic factors and estimated prevalence ratios (PR) as the effect measure. We assessed outcomes by IDD-type (intellectual disability, genetic conditions, cerebral palsy, and autism spectrum disorder) to explore differences by categories of IDD. RESULTS Of 267,395 infants, 1696 (0.6%) had mothers with IDD. A greater percentage of infants with mothers with IDD were born preterm (12.8% vs 7.8%; PR 1.64, 95% confidence interval [CI] 1.42, 1.89), small for gestational age (8.5% vs 5.4%; PR 1.42, 95% CI 1.25, 1.61), and died within 12 months of birth (3.2% vs 0.7%; PR 4.93, 95% CI 3.73, 6.43) compared to infants of mothers without IDD. Prevalence ratios were robust to adjustment for demographics factors. Estimates did not meaningfully differ when comparing different IDD-types. CONCLUSIONS A greater porportion of infants born to mothers with IDD who were covered by Medicaid had poor outcomes compared to other infants. Prevalence of poor infant outcomes was greater for mothers with IDD even after accounting for demographic differences. It is imperative to understand why infants of mothers with IDD are at greater risk so interventions and management can be developed.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Deborah B. Ehrenthal
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David C. Mallinson
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lauren Bishop
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Sandra Rosenbaum Department of Social Work, University of Wisconsin-Madison, Madison, WI, USA
| | - Hsiang-Hui Kuo
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maureen S. Durkin
- Waisman Center, University of Wisconsin- Madison, Madison, Wi, USA
- Department of Population Health Science, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Tarasoff LA, Murtaza F, Carty A, Salaeva D, Hamilton AD, Brown HK. Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis. Pediatrics 2020; 146:peds.2020-1635. [PMID: 33203648 PMCID: PMC7786829 DOI: 10.1542/peds.2020-1635] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring. OBJECTIVE We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020. STUDY SELECTION Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English. DATA EXTRACTION We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses. RESULTS Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes. LIMITATIONS Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation. CONCLUSIONS In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.
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Affiliation(s)
- Lesley A. Tarasoff
- Department of Health and Society and,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | | | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dinara Salaeva
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Hilary K. Brown
- Department of Health and Society and,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Shin JE, Cho GJ, Bak S, Won SE, Han SW, Bin Lee S, Oh MJ, Kim SJ. Pregnancy and neonatal outcomes of women with disabilities: a nationwide population-based study in South Korea. Sci Rep 2020; 10:9200. [PMID: 32514114 PMCID: PMC7280207 DOI: 10.1038/s41598-020-66181-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/15/2020] [Indexed: 11/29/2022] Open
Abstract
We investigated (1) pregnancy and neonatal outcomes in women with and without disabilities, (2) time trends in deliveries, and (3) risks of pregnancy and neonatal complications among women with various disability types and severity. This was a nationwide population-based study merging the database of the Korea National Health Insurance claims, National Health Screening Program for Infants and Children, and Disability Registration System to compare perinatal outcomes in women with and without disabilities. Pregnancy and neonatal outcomes were analyzed during 2007 and 2015, as were time trends of deliveries. Multivariate logistic regression was used to evaluate risk of perinatal outcomes among women with various disability types and severities. Women with disabilities showed higher rates of cesarean section (aOR, 1.73; 95% CI, 1.69–1.77), hypertensive disorders (aOR, 1.74; 95% CI, 1.63–1.86), placenta abruption (aOR, 1.27; 95% CI, 1.12–1.45), placenta previa (aOR, 1.14; 95% CI, 1.05–1.24), stillbirths (aOR, 1.30; 95% CI, 1.17–1.45), preterm births (aOR, 1.67; 95% CI, 1.57–1.78), and LBW (aOR, 1.87; 95% CI, 1.78–1.97) than those without disabilities. From 2007 to 2015, although delivery rate in women with disabilities decreased steeply compared with that in women without disabilities, the rate of cesarean section increased in women with disabilities. Women with intellectual disability and those with vision impairment had the highest number of perinatal complications among women with various types of disabilities. Women with disability had more adverse pregnancy and neonatal outcomes than those without disabilities. Specific disability types & severities are more vulnerable to specific perinatal complications.
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Affiliation(s)
- Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Seongeun Bak
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Eun Won
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Han
- School of Industrial Management Engineering, Korea University, Seoul, Korea
| | - Soo Bin Lee
- School of Industrial Management Engineering, Korea University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Seoul, Korea
| | - Sa Jin Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Salaeva D, Tarasoff LA, Brown HK. Health care utilisation in infants and young children born to women with intellectual and developmental disabilities: A systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:303-310. [PMID: 31997428 DOI: 10.1111/jir.12720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/25/2019] [Accepted: 01/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mothers with intellectual and developmental disabilities (IDD) experience socio-economic and health disparities which could impact their offspring's health care utilisation. We systematically reviewed evidence on health care utilisation in infants and young children of women with and without IDD. METHODS MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from inception to October 2019 for studies examining preventive care, immunisations, emergency department visits, and hospitalisations. Data extraction and quality assessment were performed using standardised tools. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were generated using random effects models for outcomes with data available from ≥3 studies. RESULTS Four articles describing three cohort studies and one cross-sectional study met our criteria. Maternal IDD status was associated with increased neonatal intensive care unit admission rates (pooled OR 2.03; 95% CI 1.31, 3.13). There were no differences in immunisation rates or hospitalisations. CONCLUSIONS Few studies have examined the impact of maternal IDD status on health care utilisation in their infants and young children. More high-quality studies are needed.
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Affiliation(s)
- D Salaeva
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - L A Tarasoff
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - H K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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Fairthorne J, Bourke J, O'Donnell M, Wong K, de Klerk N, Llewellyn G, Leonard H. Pregnancy and birth outcomes of mothers with intellectual disability and their infants: Advocacy needed to improve well-being. Disabil Health J 2019; 13:100871. [PMID: 31806497 DOI: 10.1016/j.dhjo.2019.100871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pregnancy in women with intellectual disability (ID) is increasingly recognised, along with their increased likelihood of experiencing risk factors for adverse pregnancy and infant outcomes. OBJECTIVES We aimed to compare risks of socio-demographic, pregnancy and infant outcomes of women with ID to other women. METHODS All mothers with children born in Western Australia from 1983 to 2012 were linked to the population-based Intellectual Disability Exploring Answers database. Mothers with ID were matched by age and Aboriginality to a population sample of mothers without ID. Pregnancy and birth outcomes were compared for both groups and logistic regression was used to compare outcome risks. RESULTS Compared to non-Aboriginal mothers without ID, non-Aboriginal mothers with ID were more likely to be of low socio-economic status, be without partner, smoke antenatally and have pre-existing asthma. They had a 1.5 times increased risk of pregnancy complications, specifically pre-eclampsia, urinary tract infection, threatened preterm labour and post-partum haemorrhage. After adjustment for maternal medical conditions and pregnancy complications, infants of Aboriginal mothers with ID had twice the risk of preterm birth and 1.6 times the risk of having percentage of optimal head circumference <95% compared to infants of Aboriginal mothers without ID. Infants of both Aboriginal and non-Aboriginal mothers with ID were more likely to have percentage of optimal birth weight <85% compared to those without ID. CONCLUSIONS For mothers with ID, modifiable risk factors for adverse outcomes need addressing. They may require additional assistance during pregnancy, including more frequent consultations and support to assist with pregnancy management.
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Affiliation(s)
- Jenny Fairthorne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Nick de Klerk
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
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Litchman ML, Tran MJ, Dearden SE, Guo JW, Simonsen SE, Clark L. What Women With Disabilities Write in Personal Blogs About Pregnancy and Early Motherhood: Qualitative Analysis of Blogs. JMIR Pediatr Parent 2019; 2:e12355. [PMID: 31518332 PMCID: PMC6715048 DOI: 10.2196/12355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/26/2018] [Accepted: 01/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND More than 1 in 10 women of reproductive age identify as having some type of disability. Most of these women are able to become pregnant and have similar desires for motherhood as women without disability. Women with disability, however, face greater stigma and stereotyping, additional risk factors, and may be less likely to receive adequate reproductive health care compared with their peers without disability. More and more individuals, including those with disability, are utilizing the internet to seek information and peer support. Blogs are one source of peer-to-peer social media engagement that may provide a forum for women with disability to both share and obtain peer-to-peer information and support. Nevertheless, it is not clear what content about reproductive health and pregnancy and/or motherhood is featured in personal blogs authored by women with spinal cord injury (SCI), traumatic brain injury (TBI), spina bifida, and autism. OBJECTIVE The objective of this study was twofold: (1) to examine the information being shared in blogs by women with 4 types of disabilities, namely, SCI, TBI, spina bifida, and autism, about reproductive health, disability, health care, pregnancy, and motherhood; and (2) to classify the content of reproductive health experiences addressed by bloggers to better understand what they viewed as important. METHODS Personal blogs were identified by searching Google with keywords related to disabilities, SCI, TBI, spina bifida, and autism, and a variety of keywords related to reproductive health. The first 10 pages of each database search in Google, based on the relevance of the search terms, were reviewed and all blogs in these pages were included. Blog inclusion criteria were as follows: (1) written by a woman or care partner (ie, parent or spouse) of a woman with a self-identified diagnosis of SCI, TBI, spina bifida, or autism; (2) focused on the personal experience of health and health care during the prepregnancy, prenatal, antepartum, intrapartum, and/or postpartum periods; (3) written in English; and (4) published between 2013 and 2017. A descriptive and thematic qualitative analysis of blogs and corresponding comments was facilitated with NVivo software and matrix analysis. RESULTS Our search strategy identified 125 blogs that met all the inclusion criteria; no blogs written by women with spina bifida were identified. We identified 4 reproductive health themes featured in the blog of women with disabilities: (1) (in)accessible motherhood, (2) (un)supportive others, (3) different, but not different, and (4) society questioning motherhood. CONCLUSIONS This analysis of personal blogs about pregnancy and health care written by women with SCI, TBI, and autism provides a glimpse into their experiences. The challenges faced by these women and the adaptations they made to successfully navigate pregnancy and early motherhood provide insights that can be used to shape future research.
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Affiliation(s)
| | - M J Tran
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Susan E Dearden
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Sara E Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Lauren Clark
- College of Nursing, University of Utah, Salt Lake City, UT, United States
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13
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Mueller BA, Crane D, Doody DR, Stuart SN, Schiff MA. Pregnancy course, infant outcomes, rehospitalization, and mortality among women with intellectual disability. Disabil Health J 2019; 12:452-459. [PMID: 30692054 DOI: 10.1016/j.dhjo.2019.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnant women with intellectual disability (ID) may have greater levels of comorbidity and decreased care access, social support, or ability to monitor their status and communicate needs, but few studies have examined their pregnancy course and outcome, and little is known about their longer-term maternal and infant health. OBJECTIVE We compared pre-pregnancy characteristics, pregnancy outcomes, and rehospitalization <2 years after delivery among women with and without ID. METHOD We identified all women with ID and randomly selected a 10:1 comparison group of women without ID with singleton live birth deliveries in Washington State population-based linked birth-hospital discharge data 1987-2012. Multivariable regressions estimated adjusted odds ratios comparing pre-pregnancy characteristics. In cohort analyses, we estimated relative risks (RR) and 95% confidence intervals (CI) for outcomes. RESULTS Women with ID (N = 103) more often had gestational diabetes (RR 3.39, 95% CI 1.81-6.37), preeclampsia (RR 1.88, 95% CI 1.03-3.42), and inadequate prenatal care (RR 2.48, 95% CI 1.67-3.70). Their infants more often were small for gestational age (RR 1.78, 95% CI 1.10-2.89). Need for rehospitalization postpartum was not increased among women with ID or their infants. CONCLUSION Reasons for increased preeclampsia and gestational diabetes among pregnant women with ID are unclear. Barriers to inadequate prenatal care are multifactorial and warrant further study, with consideration that wellness during pregnancy and other times involves social, familial and clinical support systems responsive to each woman's needs.
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Affiliation(s)
- Beth A Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Deborah Crane
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - David R Doody
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sally N Stuart
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | - Melissa A Schiff
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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14
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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.
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Wickström M, Höglund B, Larsson M, Lundgren M. Increased risk for mental illness, injuries, and violence in children born to mothers with intellectual disability: A register study in Sweden during 1999-2012. CHILD ABUSE & NEGLECT 2017; 65:124-131. [PMID: 28135626 DOI: 10.1016/j.chiabu.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/08/2016] [Accepted: 01/05/2017] [Indexed: 05/27/2023]
Abstract
Several studies have demonstrated that mothers with intellectual disability (ID) have a higher prevalence of mental health illness, lower socio-economic status, and a higher risk of alcohol and drug use compared to mothers without ID. The children of mothers with ID are over-represented in child protection and legal proceedings but are generally a less studied group than the mothers. The aim of this study was to investigate if children born to mothers with ID had an increased risk of being diagnosed with mental illness, injuries, and violence compared with children of mothers without ID. The study comprised a population-based cohort of children born in Sweden between 1999 and 2005. Data were collected from the Medical Birth Register and linked with two other national registers; ICD-10 codes were used for medical diagnoses, including ID. The children were followed from birth to seven years of age. In total, 478,577 children were included, of whom 2749 were born to mothers with ID. Children of mothers with ID were at a greater risk of having mental health problems (adjusted odds ratio (OR)=2.02; 95% confidence interval (CI)=1.74-2.35) and ID (OR=4.14; CI=2.95-5.82) in early childhood. They had an increased risk for injuries due to falls (OR=1.15; Cl 1.04-1.27). The largest risk related to trauma was violence and child abuse (OR=3.11; CI=1.89-5.12). In conclusion, children of mothers with ID had an increased risk for injuries, violence, and child abuse. We therefore suggest that parents with ID should receive evidence based support so that their children receive the best care and protection.
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Affiliation(s)
- Maria Wickström
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Berit Höglund
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Margareta Larsson
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Maria Lundgren
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
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Guay A, Aunos M, Collin-Vézina D. Mothering with an Intellectual Disability: A Phenomenological Exploration of Making Infant-Feeding Decisions. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:511-520. [DOI: 10.1111/jar.12298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Amanda Guay
- School of Social Work; McGill University; Montreal QC Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l’île-de-Montréal; Lachine QC Canada
| | - Marjorie Aunos
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Ouest-de-l’île-de-Montréal; Lachine QC Canada
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17
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Brown HK, Cobigo V, Lunsky Y, Dennis CL, Vigod S. Perinatal Health of Women with Intellectual and Developmental Disabilities and Comorbid Mental Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:714-723. [PMID: 27310242 PMCID: PMC5066551 DOI: 10.1177/0706743716649188] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Women with intellectual and developmental disabilities (IDD) have high rates of adverse perinatal outcomes. However, the perinatal health of women with co-occurring IDD and mental illness (dual diagnosis) is largely unknown. Our objectives were to 1) describe a cohort of women with dual diagnosis in terms of their social and health characteristics and 2) compare their risks for adverse maternal and neonatal outcomes to those of women with IDD only. METHOD We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton obstetric deliveries to women with dual diagnosis (n = 2080) and women with IDD only (n = 1852; 2002-2012). Primary maternal outcomes were gestational diabetes, gestational hypertension, preeclampsia/eclampsia, and venous thromboembolism. Primary neonatal outcomes were preterm birth, small for gestational age, and large for gestational age. We also examined several secondary outcomes. RESULTS Women with dual diagnosis were more likely than women with IDD only to live in poor neighborhoods and to have prepregnancy health conditions; however, they had more frequent prenatal care. Infants born to women with dual diagnosis had increased risks for preterm birth (adjusted relative risk [aRR] 1.31, 95% confidence interval [CI] 1.08 to 1.59) and neonatal morbidity (aRR 1.35, 95% CI 1.03 to 1.76) compared with infants born to women with IDD only. All other primary and secondary outcomes were nonsignificant. CONCLUSIONS Comorbid mental illness contributes little additional risk for adverse perinatal outcomes among women with IDD. Women with dual diagnosis and women with IDD alone require increased surveillance for maternal and neonatal complications.
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Affiliation(s)
- Hilary K Brown
- Women's College Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Virginie Cobigo
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada University of Ottawa, Ottawa, Ontario, Canada
| | - Yona Lunsky
- University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Women's College Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Powell RM, Parish SL, Akobirshoev I. Health of Young Children Whose Mothers Have Intellectual Disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 121:281-294. [PMID: 27351697 PMCID: PMC9402285 DOI: 10.1352/1944-7558-121.4.281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Understanding the needs and experiences of parents with intellectual disability (ID) and their children is critical to ensuring that policies can effectively support these families. This research analyzed data from the Fragile Families and Child Wellbeing Study to examine the health outcomes of U.S. children whose mothers have (n = 263) and do not have ID (n = 1,298). Compared to mothers without ID, mothers with ID experienced worse outcomes related to socioeconomic status, limited support networks, and poor self-reported health. However, after controlling for sociodemographic characteristics, mother's intellectual disability was not associated with a child having fair or poor health, asthma, or being overweight or obese.
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Affiliation(s)
- Robyn M Powell
- Robyn M. Powell, Susan L. Parish, and Ilhom Akobirshoev, Brandeis University, Waltham, MA
| | - Susan L Parish
- Robyn M. Powell, Susan L. Parish, and Ilhom Akobirshoev, Brandeis University, Waltham, MA
| | - Ilhom Akobirshoev
- Robyn M. Powell, Susan L. Parish, and Ilhom Akobirshoev, Brandeis University, Waltham, MA
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19
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Brown HK, Cobigo V, Lunsky Y, Vigod SN. Maternal and offspring outcomes in women with intellectual and developmental disabilities: a population-based cohort study. BJOG 2016; 124:757-765. [DOI: 10.1111/1471-0528.14120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- HK Brown
- Women's College Research Institute and University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | - V Cobigo
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | - Y Lunsky
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
- Centre for Addiction and Mental Health and University of Toronto; Toronto ON Canada
| | - SN Vigod
- Women's College Research Institute and University of Toronto; Toronto ON Canada
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
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20
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Mitra M, Clements KM, Zhang J, Iezzoni LI, Smeltzer SC, Long-Bellil LM. Maternal Characteristics, Pregnancy Complications, and Adverse Birth Outcomes Among Women With Disabilities. Med Care 2015; 53:1027-32. [PMID: 26492209 PMCID: PMC4648667 DOI: 10.1097/mlr.0000000000000427] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. METHODS Data from the 2002-2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. RESULTS Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6-15.6 compared with 8.9%; 95% CI, 8.5-9.3 for women without disabilities) and low-birth-weight babies (10.3%; 95% CI, 9.4-11.2 compared with 6.8%; 95% CI, 6.8-6.9). There was no difference in the rates of cesarean section between women with and without disabilities. CONCLUSIONS These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.
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Affiliation(s)
- Monika Mitra
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8548 voice, 508-856-8543 fax
| | - Karen M. Clements
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-3193 voice, 508-856-8543 fax
| | - Jianying Zhang
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8221 voice, 508-856-8543 fax
| | - Lisa I. Iezzoni
- The Mongan Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, Room 901B, Boston, MA 02114, 617-643-0657 voice, 617-724-4738 fax
| | - Suzanne C. Smeltzer
- Center for Nursing Research, Villanova University, 800 Lancaster Avenue, Villanova, PA 19085, 610-519-6828 voice, Fax: 610-519-7650 fax
| | - Linda M. Long-Bellil
- Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury MA 01545, 508-856-8417 voice, 508-856-8543 fax
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21
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Brown HK, Kirkham YA, Cobigo V, Lunsky Y, Vigod SN. Labour and delivery interventions in women with intellectual and developmental disabilities: a population-based cohort study. J Epidemiol Community Health 2015; 70:238-44. [PMID: 26449738 DOI: 10.1136/jech-2015-206426] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Our objectives were to: (1) examine the occurrence of labour induction, caesarean section, and operative vaginal delivery in women with intellectual and developmental disabilities compared to those without and (2) determine whether pre-pregnancy health conditions and pregnancy complications explain any elevated occurrence of these interventions. METHODS We conducted a population-based study using linked Ontario (Canada) administrative data. We identified deliveries to women with (N=3932) and without (N=382,774) intellectual and developmental disabilities (2002-2011). Modified Poisson regression was used to estimate adjusted relative risks (aRR) and 95% CIs for interventions, controlling for sociodemographic characteristics. We used generalised estimating equations to determine whether pre-pregnancy health conditions and pregnancy complications explained any statistically significantly elevated aRRs. RESULTS After controlling for socio-demographic characteristics, women with intellectual and developmental disabilities were more likely to have labour inductions (aRR, 1.13; 95% CI 1.06 to 1.20) and caesarean sections (aRR, 1.09; 95% CI 1.03 to 1.16) but not operative vaginal deliveries, compared to the referent group. Pre-pregnancy health conditions explained 12.9% of their elevated aRR for labour induction. Pre-pregnancy health conditions and maternal complications explained 27.8% and 13.3%, respectively, of their elevated aRR for caesarean section. CONCLUSIONS Women with intellectual and developmental disabilities are slightly more likely to have labour inductions and caesarean sections than women without intellectual and developmental disabilities. The elevated occurrence of these interventions is not fully explained by their pre-pregnancy health conditions or pregnancy complications. Non-medical issues should be evaluated for their influence on the timing of labour and delivery in this population.
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Affiliation(s)
- Hilary K Brown
- Women's College Research Institute, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yolanda A Kirkham
- Women's College Hospital, Toronto, Ontario, Canada Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Virginie Cobigo
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone N Vigod
- Women's College Research Institute, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Women's College Hospital, Toronto, Ontario, Canada
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Parish SL, Mitra M, Son E, Bonardi A, Swoboda PT, Igdalsky L. Pregnancy Outcomes Among U.S. Women With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 120:433-443. [PMID: 26322390 DOI: 10.1352/1944-7558-120.5.433] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The existing research on pregnancy outcomes for women with intellectual and developmental disabilities (IDD) is sparse. This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared deliveries among women with IDD (n = 340) to the general obstetric population. Women with IDD had longer hospital stays and were more likely to have Caesarean deliveries in contrast to other women. Rates of adverse pregnancy outcomes were elevated for women with IDD across a range of measures, including early labor, preterm birth, and preeclampsia, and their infants were more likely to have low birth weight, even after adjusting for age, race, ethnicity, and insurance type. Targeted interventions are needed to address these deleterious outcomes.
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Hindmarsh G, Llewellyn G, Emerson E. Mothers with intellectual impairment and their 9-month-old infants. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2015; 59:541-550. [PMID: 25208604 DOI: 10.1111/jir.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Few studies have utilised population-based data to examine the lives of families headed by parents with intellectual impairment. This study examined the health and social context of mothers with intellectual impairment compared with their peers without intellectual impairment, and the 9-month developmental outcomes of their infants. METHOD Secondary analysis of the first wave of the United Kingdom's Millennium Cohort Study (MCS). Wave 1 data were collected when the child was 9 months of age and recorded in-depth information of maternal health, the social context in which the families live, and developmental outcomes of the infants. RESULTS Of the 18 189 mothers, 74 (0.4%) were classified as mothers with intellectual impairment. The findings show evidence of widespread disadvantage in terms of social context and poorer self-reported physical health for mothers with intellectual impairment compared with their peers without intellectual impairment. Maternal mental health and the developmental outcomes of their 9-month infants were not markedly different between the two groups. CONCLUSIONS The cross-sectional analyses used in this study shows the differences in the lives of mothers with intellectual impairment and their young infants compared with their peers. Longitudinal analyses across subsequent waves of the MCS will allow protective and risk factors in the early years that influence later developmental outcomes to be identified.
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Affiliation(s)
- G Hindmarsh
- Australian Family & Disability Studies Research Collaboration, University of Sydney, Lidcombe, NSW, Australia
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Mitra M, Parish SL, Clements KM, Cui X, Diop H. Pregnancy outcomes among women with intellectual and developmental disabilities. Am J Prev Med 2015; 48:300-8. [PMID: 25547927 DOI: 10.1016/j.amepre.2014.09.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is currently no population-based research on the maternal characteristics or birth outcomes of U.S. women with intellectual and developmental disabilities (IDDs). Findings from small-sample studies among non-U.S. women indicate that women with IDDs and their infants are at higher risk of adverse health outcomes. PURPOSE To describe the maternal characteristics and outcomes among deliveries to women with IDDs and compare them to women with diabetes and the general obstetric population. METHODS Data from the 1998-2010 Massachusetts Pregnancy to Early Life Longitudinal database were analyzed between November 2013 and May 2014 to identify in-state deliveries to Massachusetts women with IDDs. RESULTS Of the 916,032 deliveries in Massachusetts between 1998 and 2009, 703 (<0.1%) were to women with IDDs. Deliveries to women with IDDs were to those who were younger, less educated, more likely to be black and Hispanic, and less likely to be married. They were less likely to identify the father on the infant's birth certificate, more likely to smoke during pregnancy, and less likely to receive prenatal care during the first trimester compared to deliveries to women in the control groups (p<0.01). Deliveries to women with IDDs were associated with an increased risk of adverse outcomes, including preterm delivery, very low and low birth weight babies, and low Apgar scores. CONCLUSIONS Women with IDDs are at a heightened risk for adverse pregnancy outcomes. These findings highlight the need for a systematic investigation of the pregnancy-related risks, complications, costs, and outcomes of women with IDDs.
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Affiliation(s)
- Monika Mitra
- Department of Family Medicine and Community Health.
| | - Susan L Parish
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham
| | - Karen M Clements
- Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury
| | - Xiaohui Cui
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Hafsatou Diop
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts
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Abstract
Parenting by people with intellectual disability continues to confront societal sensibilities. On the one hand, parents with intellectual disability engage in the valued social role of raising children; on the other, their parenting attracts (typically negative) attention based on an expectation of their limited capacities to parent. The literature primarily addresses the question of whether or not parents with intellectual disability can be adequate parents or reports on methods for improving their parenting skills. An emerging trend in the literature over the last decade takes a different perspective. Rather than concentrating exclusively on parents with intellectual disability, this perspective focuses on their parenting situation compared to that of other parents more generally. This paper reviews the current state of knowledge about parents and parenting with intellectual disability in this broader population context. The focus of the paper is on the use of larger scale datasets to understand the situation of parents with intellectual disability compared with other parents and to examine the contextual variables that influence their parenting.
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Lindblad I, Billstedt E, Gillberg C, Fernell E. A register study of life events in young adults born to mothers with mild intellectual disability. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2014; 18:351-363. [PMID: 25253089 DOI: 10.1177/1744629514552150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up. METHODS The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study. However, of the remaining 28, it was not possible to establish contact with 21 who were instead searched for in various official registers. RESULTS Most (n = 18) individuals in the study group had been in contact with different authorities and clinics. Of the 21 individuals, 10 had contact with social services since childhood and 4 of these had been taken into care (foster family) and 6 had had contact families during childhood. One individual had been taken into a treatment centre and one grew up mainly with the father. Altogether 12 (57%) of 21 individuals did not grow up full-time with their biological mother. Twelve (57%) had major neurodevelopmental/neuropsychiatric conditions, including five with ID and seven with attention-deficit hyperactivity disorder (ADHD). Four individuals were registered within the Prison and Probation Service due to various types of crimes. CONCLUSION Individuals born to mothers with ID in our study group were at high risk of adverse experiences and negative outcomes, such as increased childhood mortality, a relatively large proportion of children taken into care, high rates of ID and ADHD in the children and of criminality in young adulthood. Taken together with the results obtained in an in-depth interview study of those in the originally targeted sample with whom it was possible to obtain contact, the present findings suggest that it will be important to provide early support and longitudinal developmental follow-up in groups of children growing up with a mother with ID. Children in this situation appear to be at a number of risks, probably related both to hereditary factors and to social disadvantage.
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A comparison of maternal and neonatal outcomes of pregnancy with mental disorders: results of an analysis using propensity score-based weighting. Arch Gynecol Obstet 2014; 290:883-9. [DOI: 10.1007/s00404-014-3304-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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Emerson E, Brigham P. The developmental health of children of parents with intellectual disabilities: cross sectional study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:917-921. [PMID: 24485469 DOI: 10.1016/j.ridd.2014.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/03/2014] [Indexed: 06/03/2023]
Abstract
In a representative population-based sample of 46,025 families caring for a young child, parental intellectual disability (identified in 588 families) was associated with increased risk of child developmental delay, child speech and language problems, child behaviour problems and frequent child accidents and injuries. Parental intellectual disability was also associated with increased risk of exposure to a wide range of environmental adversities such as poverty, poor housing and social isolation. Adjusting for between-group differences in exposure to low socio-economic position reduced the risk of adverse child outcomes by over 50% on each of the four measures of child developmental health. In the final fully adjusted model parental intellectual disability was associated with increased risk of child developmental delay and child speech and language problems. However, there were no significant associations between parental intellectual disability and child behaviour problems or frequent accidents and injuries.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW 2141, Australia.
| | - Philip Brigham
- Public Health, Cornwall Council, NHS England, Peninsula House, Kingsmill Road, Saltash PL12 6LE, UK.
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Llewellyn G. Mothers with intellectual disability and their babies: a population warranting special consideration. Acta Obstet Gynecol Scand 2013; 91:1353-6. [PMID: 23210534 DOI: 10.1111/aogs.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Biological factors and/or the mothers' social-environmental situation may be responsible for the much higher relative risk for pregnant intellectually disabled women and their newborns reported in articles by Höglund et al. in this issue. This population has increased exposure to key social determinants of health such as poverty and social exclusion. This is compounded by institutional discriminatory beliefs and practices. People with intellectual disability may also struggle to communicate their needs effectively and to be heard and understood by health professionals. Further research is warranted to understand the reasons for two stand-out findings: why rates of stillbirth and perinatal death are significantly higher in this group and whether varying obstetric practices are responsible for the significantly lower use of pain relief during childbirth. Quality health care requires that due attention is given to meeting the specific needs of this vulnerable group of mothers and their newborns.
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Affiliation(s)
- Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
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