Pregnancy Outcomes Among U.S. Women With Intellectual and Developmental Disabilities

Perinatal and Postpartum Health Among People With Intellectual and Developmental Disabilities

Importance

Small, geographically limited studies report that people with intellectual and developmental disabilities (IDD) have increased risk for serious pregnancy-related and birth-related challenges, including preeclampsia, preterm birth, and increased anxiety and depression, than their peers. United States-based population-level data among people with IDD are lacking.

Objectives

To identify perinatal and postpartum outcomes among a national, longitudinal sample of people with IDD enrolled in public health insurance, compare subgroups of people with IDD, and compare outcomes among people with IDD with those of peers without IDD.

Design, Setting, and Participants

This retrospective cohort study used national Medicaid claims from January 1, 2008, to December 31, 2019, for 55 440 birthing people with IDD and a random sample of 438 557 birthing people without IDD. Medicaid funds almost half of all births and is the largest behavioral health insurer in the US, covering a robust array of services for people with IDD. Statistical analysis was performed from July 2023 to June 2024.

Exposure

People who had a documented birth in Medicaid during the study years.

Main Outcome and Measures

Perinatal outcomes were compared across groups using univariate and multivariate logistic regression. The probability of postpartum anxiety and depression was estimated using Kaplan-Meier and Cox proportional hazards regression.

Results

The study sample included 55 440 birthing people with IDD (including 41 854 with intellectual disabilities [ID] and 13 586 with autism; mean [SD] age at first delivery, 24.9 [6.7] years) and a random sample of 438 557 birthing people without IDD (mean [SD] age at first delivery, 26.4 [6.3] years). People with IDD were younger at first observed delivery, had a lower prevalence of live births (66.6% vs 76.7%), and higher rates of obstetric conditions (gestational diabetes, 10.3% vs 9.9%; gestational hypertension, 8.7% vs 6.1%; preeclampsia, 6.1% vs 4.4%) and co-occurring physical conditions (heart failure, 1.4% vs 0.4%; hyperlipidemia, 5.3% vs 1.7%; ischemic heart disease, 1.5% vs 0.4%; obesity, 16.3% vs 7.4%) and mental health conditions (anxiety disorders, 27.9% vs 6.5%; depressive disorders, 32.1% vs 7.5%; posttraumatic stress disorder, 9.5% vs 1.2%) than people without IDD. The probability of postpartum anxiety (adjusted hazard ratio [AHR], 3.2 [95% CI, 2.9-3.4]) and postpartum depression (AHR, 2.4 [95% CI, 2.3-2.6]) was significantly higher among autistic people compared with people with ID only and people without IDD.

Conclusions and Relevance

In this retrospective cohort study, people with IDD had a younger mean age at first delivery, had lower prevalence of live births, and had poor obstetric, mental health, and medical outcomes compared with people without IDD, pointing toward a need for clinician training and timely delivery of maternal health care. Results highlight needed reproductive health education, increasing clinician knowledge, and expanding Medicaid to ensure access to care for people with IDD.

Mental health and service use of parents with and without borderline intellectual functioning

BACKGROUND

People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF.

METHODS

A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment.

RESULTS

Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems.

CONCLUSIONS

Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.

Family Caregivers' Attitudes and Perspectives About the Sexual and Reproductive Health of Women With Intellectual and Developmental Disabilities: An Online Survey

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.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

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.

The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review

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.

Pregnancy recommendations from women with intellectual and developmental disabilities to their peers

BACKGROUND

As recent as the mid-twentieth century, eugenics practices on women with intellectual and developmental disabilities were commonplace. Deinstitutionalization has led to an increasing proportion of women with intellectual and developmental disabilities living in the community and becoming pregnant. Previous research has reported barriers to maternal health care (i.e., perceived provider stigma, inadequate communication, stress surrounding child protective services involvement, and financial strain). Research shows that this population is at increased risk of adverse outcomes including preterm delivery, low birth weight babies, and maternal mortality.

OBJECTIVE/HYPOTHESIS

This study aimed to explore recommendations from mothers with intellectual and developmental disabilities for other women to potentially improve pregnancy experiences for this population.

METHODS

We conducted semi-structured individual interviews among 16 women with intellectual and developmental disabilities. Data were coded using a content analysis process and iteratively analyzed using inductive and deductive techniques to determine emergent themes.

RESULTS

Participants offered recommendations for navigating pregnancy to their peers who are pregnant, or thinking about becoming pregnant. Themes included: (1) planning for birth; (2) advocating at the point-of-care; (3) seeking supports and services; (4) interacting with child protective services; (5) communicating with providers; and (6) exhibiting resilience.

CONCLUSION

Our study highlights recommendations for improving pregnancy experiences of women with intellectual and developmental disabilities. Informed by the lived pregnancy experiences of our participants, these recommendations can inform clinician training, new guidelines, and services to support and improve pregnancy experiences for women with intellectual and developmental disabilities.

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

BACKGROUND

Little is known about severe maternal morbidity (SMM) among women with disabilities.

OBJECTIVE

We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities.

METHODS

We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23-42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate-adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes.

RESULTS

Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities).

CONCLUSION

As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.

Formal and Informal Supports for Women With Intellectual and Developmental Disabilities During Pregnancy

This article explores the role of formal and informal supports for women with intellectual and developmental disabilities (IDD) throughout their pregnancy, childbirth, and postpartum experiences. Data from qualitative interviews with women with IDD (n = 16) were analyzed. Results showed that formal supports aided in planning, transportation, advocacy, and providing emotional support throughout pregnancy. Informal supports helped with errands, comfort, and emotional encouragement. The community surrounding these women facilitated communication with providers, self-empowerment regarding health choices, and increased preparedness for parenthood. Findings indicate the importance of encouraging and sustaining both formal and informal supports during pregnancy, childbirth, and postpartum to improve pregnancy and parenting experiences for women with IDD.

Evidence-Based Early Home Visiting for Mothers and Parents With Intellectual Disability: Home Visitor Perceptions and Practices

Evidence-based maternal, infant, and early home visiting (EBHV) is a potential strategy to support parent and child health and well-being among families headed by a parent with an intellectual disability (ID). Little is known about the capacity of EBHV programs to meet the needs of parents with ID effectively. This study examined home visitor practices and perceptions of services for parents with ID. Home visiting staff recruited from a national practice-based research network participated in web-based surveys. Practices and perceptions varied widely across sites and were associated with home visitor knowledge and self-efficacy and site implementation supports, such as policies, curricula, and community collaboration. More work is needed to understand and strengthen EBHV services for parents with ID.

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

Background

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

Method

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

Results

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

Conclusions

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

Incarceration exposure during pregnancy and maternal disability: findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Extant research reveals that currently and formerly incarcerated individuals exhibit higher rates of disability. Moreover, recent research highlights that women exposed to incarceration during pregnancy -either personally or vicariously through a partner- face poorer health. However, prior research has not detailed the connection between incarceration exposure and risk for maternal disability.

METHODS

The aim of this study is to evaluate the association between a women's exposure to incarceration during pregnancy and disability including difficulty with: communication, hearing, remembering, seeing, self-care, or walking. Data are from Pregnancy Risk Assessment Monitoring System (PRAMS), 2019 (N = 12,712). Logistic and negative binomial regression were used to assess the relationship between incarceration exposure and maternal disability.

RESULTS

Among the sample of women who delivered a recent live birth, approximately 3.3% of the sample indicated they were personally or vicariously exposed to incarceration in the 12 months before birth. Compared to those who did not have incarceration exposure, women with incarceration exposure have elevated odds of several disabilities, including difficulty remembering (Adjusted Odds Ratio [AOR] = 1.971; 95% Confidence Interval [CI] = 1.429, 2.718), difficulty seeing (AOR = 1.642, 95% CI = 1.179, 2.288), difficulty walking (AOR = 1.896, 95% CI = 1.413, 2.544), and a greater number of cumulative disabilities (Incidence Risk Ratio [IRR] = 1.483; 95% CI = 1.271, 1.731).

CONCLUSIONS

Women personally or vicariously exposed to incarceration during pregnancy endure greater odds of having a disability. Considering both incarceration and disability are important public health issues with implications for maternal and child well-being, these findings highlight the need for further research that can better understand the connection between incarceration and disability.

Mothers and fathers with intellectual and developmental disabilities who use US disability services: prevalence and living arrangements

BACKGROUND

Little information is available on the prevalence of mothers and fathers with intellectual and developmental disabilities among US disability-service users. Child removal is a key issue for these parents.

METHODS

We analysed 2018-19 National Core Indicators data from 35 states on US adults with intellectual and developmental disabilities being a parent. For parents of a child under 18, we examined whether the child lived with them.

RESULTS

Prevalence of parenthood was 3.7% (6.0% women, 2.1% men). Among parents of a child under 18, 44.0% had their child living with them. Being a mother, being married and living with family were positively associated with child co-residence. Parents with co-resident children mainly lived in their own home (59.7%) or their family's home (32.3%).

CONCLUSIONS

Our prevalence estimate suggests a national total of 33 794 US parents who use intellectual and developmental disabilities services. For parents living with their child, a critical task for disability services is to enable parents and children to live in a family setting.

Clinician perspectives on the need for training on caring for pregnant women with intellectual and developmental disabilities

BACKGROUND

Women with intellectual and developmental disabilities (IDDs) experience disparities in obstetric care access and quality, in addition to communication gaps with healthcare providers. Many obstetric providers are untrained and uneducated about critical aspects of providing care to persons with IDDs.

OBJECTIVE

The study was conducted to describe obstetric clinicians' training experiences related to providing obstetric care to women with IDDs, to assess the perceived need for formalized training, and to identify recommendations for training content.

METHODS

This study involved qualitative individual interviews (n = 9) and one focus group (n = 8) with obstetric clinicians who self-reported experience caring for women with IDDs during pregnancy. Descriptive coding and content analysis techniques were used to develop an iterative codebook related to education and training; codes were applied to the data. Coded data were analyzed for larger themes and relationships.

RESULTS

Analysis revealed three main themes: 1. Need for obstetric training and education: No participant reported receiving any training in caring for pregnant women with IDDs. Participants expressed a need for formal education. 2. Recommendations for formal training: Participants noted the need for training during residency and beyond, and all healthcare staff members should be included in training. 3. Training outcomes should increase knowledge, enhance attitudes, and develop practical skills related to care for pregnant women with IDDs.

CONCLUSION

Results indicate a need for systematic training efforts regarding obstetric care for women with IDDs. Improved training and education may decrease health inequities and improve the quality of care, and thus pregnancy outcomes, for women with IDDs.

LEVEL OF EVIDENCE

VI.

Risk of Adverse Maternal Outcomes in Pregnant Women With Disabilities

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.

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

INTRODUCTION

Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities.

METHODS

This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis.

RESULTS

This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29).

CONCLUSIONS

Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

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.

Complications following hysterectomy in women with intellectual and developmental disabilities

BACKGROUND

Limited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD).

OBJECTIVE

The objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy.

METHODS

The National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables.

RESULTS

Of eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18-11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10-38.36).

CONCLUSIONS

Women with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.

Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

OBJECTIVES

To produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.

DESIGN

Scoping review with narrative synthesis.

METHODS

The review followed the six stages of the Arksey and O'Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria-patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.

RESULTS

45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.

CONCLUSION

People with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data

BACKGROUND

Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States.

OBJECTIVE

To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data.

STUDY DESIGN

We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics.

RESULTS

DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained.

CONCLUSIONS

DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.

Prevalence of Births and Interactions with Child Protective Services of Children Born to Mothers Diagnosed with an Intellectual and/or Developmental Disability

OBJECTIVES

Concerns have been raised that parents with intellectual and/or developmental disabilities (IDD) interact with child protective services (CPS) at disproportionate rates than the general population as a result of bias and discrimination. However, there has been little empirical evidence to ascertain if these concerns are grounded. This study's objectives were to identify (a) the prevalence and sociodemographic characteristics of children born to mothers diagnosed with IDD diagnoses, (b) how many of these children interact with CPS (reports and removals) and (c) when these CPS interactions are occurring.

METHODS

The dataset was comprised of linked administrative birth, hospital discharge, and CPS records for all children born in one U.S. state between 1999 and 2013 (N = 1,271,419). CPS records were available through the first quarter of 2018 and CPS reports and removals at the child's first and fourth birthdays were identified. We conducted chi-square tests and multivariate survival Cox regression models.

RESULTS

A total of 567 children were identified as born to mothers with IDD diagnoses, which is 4.5 per 10,000 births. Of these children, 21.7% were the subject of a CPS report within 1 year and 35.8% within 4 years. In terms of removals, 6.5% experienced removals by 1 year and 8.6% by 4 years.

CONCLUSIONS FOR PRACTICE

This study provides population-based knowledge about how and when the children born to mothers diagnosed with IDD interact with CPS. These children have higher rates of CPS interactions than the general population, but these rates are not as high as previously reported.

Perinatal outcomes of women with a disability who received pregnancy care through a specialised disability clinic in Melbourne, Australia

BACKGROUND

In Australia, it is estimated that 9.5% of women of childbearing age have a disability; however, little is known about their perinatal outcomes. Disability status is not routinely recorded in perinatal datasets.

AIMS

To compare the outcomes of women with a disability who received pregnancy care through a specialised disability clinic at the Royal Women's Hospital (the Women's) in Melbourne, Australia with hospital-wide perinatal outcome data.

MATERIALS AND METHODS

Routinely collected perinatal data for women who received pregnancy care from the 'Women with Individual Needs' (WIN) clinic from 2014-2018 (N = 111) were analysed and then compared with routinely collected electronic hospital data obtained from all women who had given birth at the Women's in 2017 and 2018 (N = 15 024).

RESULTS

Women who attended the WIN clinic were more likely to have a caesarean section birth (52% vs 32%; P < 0.001) and give birth preterm (17% vs 4%; P < 0.001) than those in the hospital-wide cohort. Their infants were more likely to be low birthweight (20% vs 9%; P < 0.001), require resuscitation (35% vs 11%; P < 0.001), be admitted to the Neonatal Intensive Special Care Unit (29% vs 13%; P < 0.001) and receive formula in hospital (54% vs 28%; P < 0.001) compared to infants in the other group.

CONCLUSIONS

Routine maternity data collection should include identification of women with a disability to enable appropriate support and to allow further exploration of potential poorer outcomes on a larger sample, to help identify factors amenable to interventions that may improve outcomes.

Associations between Disability and Infertility among U.S. Reproductive-Aged Women

We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18–49 years without history of hysterectomy or oophorectomy (NHANES, 2013–2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31–2.40)). Similar findings were observed for sensory (2.32 (1.52–3.52)) and cognitive disabilities (1.77 (1.28–2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32–1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.

Pregnancy and Parenthood Among Autistic Adults: Implications for Advancing Maternal Health and Parental Well-Being

Background

Strikingly little research has considered how autistic adults experience pregnancy and parenthood, two key transition periods in adult development with potentially far-reaching implications for physical and psychosocial health outcomes across the lifespan. This article reviews the research on pregnancy and parenthood among autistic adults, to summarize existing research and identify future directions to advance this critical area of study.

Methods

We conducted a systematic review of the literature on pregnancy and parenthood among autistic adults. Researchers extracted selected articles for key information, including methodology and sample size, study location, demographic characteristics of participants, measurement approaches, and key study findings.

Results

Overall, we identified 13 studies that used a range of quantitative and qualitative approaches to study pregnancy experiences and outcomes and parenthood among autistic adults. The findings show that autistic adults (1) experience difficulties and dissatisfaction communicating with health care providers throughout pregnancy and birth, (2) are more likely to experience depression during and after pregnancy, and (3) experience higher rates of pregnancy complications, including preterm birth, cesarean delivery, and pre-eclampsia. During parenthood, autistic adults report lower parenting competence, experience parenthood as isolating, have difficulty communicating with professionals about their child and are questioned by providers about their ability to parent, experience high rates of involvement with child protective services, and express a desire for increased parenting support. Autistic adults also reported parenting strengths, including high levels of finding parenthood rewarding and putting their children's needs ahead of their own.

Conclusions

A key limitation of the literature is the significant lack of sociodemographic diversity among participants, the small number of existing studies, and reliance on cross-sectional mono-method designs. Future research should be conducted in partnership with autistic adults to develop assessment and intervention approaches for supporting pregnancy health and parental well-being among diverse and underserved communities.

Lay summary

Why is this topic important?: Very little is known about how autistic adults experience pregnancy and parenthood. Better understanding these experiences is important, because pregnancy and parenthood are key transition periods in adult development that are associated with a range of health outcomes later in life.What is the purpose of this article?: This article reviews the existing research on pregnancy and parenthood among autistic adults. We wanted to summarize what is already known, evaluate how that knowledge was created, and consider who has and who has not been included in this research to inform future research. We summarized 13 studies that considered pregnancy or parenthood among autistic adults.What did the authors find about pregnancy among autistic adults?: One study used data from hospital and birth records in Sweden, and showed that autistic women experience higher rates of pregnancy complications, such as preterm birth (early delivery before 37 weeks), cesarean delivery, and pre-eclampsia (a condition defined by high blood pressure during pregnancy). Two studies had autistic and nonautistic adults fill out online surveys about their experiences, and found that autistic adults are more likely to have depression during and after pregnancy, have more difficulty interacting with health care professionals at pregnancy appointments and during the birth process, and feel that information and support services for pregnancy do not always meet their needs. Autistic women also reported that sensory differences can make health care visits during pregnancy especially difficult, and described that they may experience anxiety and confusion when interacting with health care staff.What did the authors find about parenthood among autistic adults?: The research we reviewed showed that autistic adults experience strengths and difficulties in parenting. Many autistic adults found parenthood rewarding, but also felt isolated as parents and had difficulty communicating with health care professionals about their children. Autistic adults also had high rates of interacting with child protective services (CPS). Some research also found that autistic adults had lower self-confidence in parenting, although findings are mixed.What are the recommendations for future research and practice?: We need to develop support strategies to promote pregnancy health and parenting satisfaction in partnership with autistic adults. For example, it may be helpful to develop communication tools that can support autistic adults during pregnancy, labor, and birth. We also recommend that future research develop questionnaires to ask autistic adults about their pregnancy and parenting experiences in sensitive ways, so that in the future providers can regularly ask autistic adults about their support needs. Most importantly, it is critical that future research also include more diverse autistic participants in their research, including racial/ethnic and sexual and gender minorities.How will these findings help autistic adults now or in the future?: We hope that this article will help guide future research that strives to better understand how autistic adults experience pregnancy and parenthood. Ultimately, we believe this research can lead to supports and intervention strategies that can improve pregnancy health and parental well-being for autistic adults.

Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis

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.

Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid

BACKGROUND

Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016.

METHODS

Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race.

RESULTS

Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model.

CONCLUSIONS

Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.

Medical indications for primary cesarean delivery in women with and without disabilities

Background: Prior research has found that women with disabilities are more likely to deliver by cesarean than are women without disabilities. It is not clear whether all of the cesarean deliveries among women with disabilities are medically necessary.Objectives: To examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries.Study design: Retrospective cohort study of all nulliparous births in California between 2000 and 2012. We classified births as to whether or not women underwent a trial of labor and determined if medical indications for cesarean delivery were present. Multivariable logistic regression models examined the association of disability with trial of labor and indications for cesarean delivery.Results: Women with disabilities had lower odds of having a labored delivery, compared to women without disabilities (adjusted odds ratio (aOR) = 0.45, 95% confidence interval (CI) 0.41-0.49). In the sample of women who labored (90.5% of total), women with disabilities were more likely to have a medical indication for cesarean delivery (aOR = 1.15, 95% CI 1.10-1.21) and were more likely to have a cesarean delivery (aOR = 1.46, 95% CI = 1.38-1.54). In the subsample of unlabored cesarean deliveries, women with disabilities were less likely to have documented medical indications for cesarean delivery (aOR = 0.45, 95% CI = 0.41-0.50).Conclusions: Women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.

Disability and Pregnancy: A Cross-Federal Agency Collaboration to Collect Population-Based Data About Experiences Around the Time of Pregnancy

Many reproductive-aged women with a disability can achieve successful healthy pregnancies; however, they may face challenges accessing prenatal and postpartum care and finding providers who are knowledgeable about their specific condition. Depending on the nature of the disability, some women may also be at increased risk for adverse maternal and infant outcomes such as pre-eclampsia, infection, anemia, primary cesarean delivery, or preterm birth. Population-based data are needed to better understand the pregnancy and postpartum experiences of women living with disability. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) collaborated to address these data gaps by leveraging CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) to gather information about disability among women who have had a recent live birth. Data collection began in 2019. Information gathered through PRAMS can be used to guide the development of clinical practices guidelines, intervention programs, and other initiatives of federal, state, and local agencies to improve services and the health of women of reproductive age living with disability.

Postpartum Health Care Among Women With Intellectual and Developmental Disabilities

INTRODUCTION

Postpartum health care among women with intellectual and developmental disabilities has not been well studied. This study uses administrative claims to compare postpartum outpatient visits among women with and without intellectual and developmental disabilities.

METHODS

Massachusetts All Payers Claims Database 2012-2015 was used to identify women with intellectual and developmental disabilities and a live birth during 2012-2014, matched by infant birth year to 3 women without intellectual and developmental disabilities. Women were followed up for 1 year after delivery. Analyses were conducted in 2019. Poisson regression compared guideline-concordant postpartum and other outpatient visits during the early (21-56 days after delivery) and late (57-365 days after delivery) periods. Types of nonpostpartum care visits were examined.

RESULTS

Overall, 962 and 2,886 women with and without intellectual and developmental disabilities, respectively, comprised the sample. Among women with intellectual and developmental disabilities, 23.9% had a postpartum visit in the early and 33.3% in the late postpartum periods, compared with 25.2% and 32.1% of women without intellectual and developmental disabilities who had visits in the early and late postpartum periods, respectively (p=0.49, 0.59). Women with intellectual and developmental disabilities were more likely to have other outpatient visits than those without intellectual and developmental disabilities, both in the early (63.1% vs 40.3%, adjusted RR=1.42, 95% CI=1.28, 1.58, p<0.001) and late (94.2% vs 82.3%, RR=1.11, 95% CI=1.08, 1.14, p=0.008) postpartum periods. Ancillary services, home health services, and alcohol/drug-related visits were much more common among women with intellectual and developmental disabilities.

CONCLUSIONS

Women with intellectual and developmental disabilities are equally likely to receive guideline-concordant postpartum visits and more likely to have other outpatient visits than other women. Further research is needed to evaluate visit quality and identify best practices to support mothers with intellectual and developmental disabilities during the postpartum period.

Recent Trends and Future Directions in Research Regarding Parents with Intellectual and Developmental Disabilities

Purpose of Review

This report updates research on parents with IDD and their children published since 2014.

Recent Findings

Since 2014, a plethora of studies using large administrative databases in different countries support a contextual approach to understand why parents with IDD and their children may have worse outcomes than other families. In most studies, increased risk of ill health in women with IDD and health and developmental problems in their children were fully or partially accounted for by socioeconomic and psychosocial hardships. New research has found that pregnant women with IDD tend to have risk factors for pregnancy, birth, and postpartum complications that may contribute to adverse child outcomes. Intervention research is gradually becoming more contextualized.

Summary

More studies are needed on multicultural aspects of parenting, programs that could help parents with IDD overcome social and health disadvantages, comprehensive and coordinated service models that start during pregnancy, innovative parent support arrangements, parenting education for teens and young adults with IDD, use of technology, and dissemination and implementation of evidence-based programs.

Prolonged postpartum length of hospital stay among women with disabilities

BACKGROUND

Prior studies have found higher proportions of cesarean deliveries and longer postpartum hospital stays among women with disabilities compared to women without disabilities. However, no research has assessed how length of stay may differ for women with different types of disability while also considering mode of delivery.

OBJECTIVE

To examine the association of disability status and disability type with length of stay, taking into account disability-related differences in mode of delivery.

METHODS

We conducted a retrospective cohort study using linked maternal and infant hospital discharge and vital records data for all births in California between 2000 and 2012 (n = 6,745,201). We used multivariable regression analyses to assess association of disability status and type with prolonged length of stay (>2 days for vaginal delivery or >4 days for cesarean) while controlling for covariates.

RESULTS

Women with disabilities had significantly elevated adjusted odds of prolonged length of stay compared to women without disabilities (aOR = 1.40, 95% CI = 1.32-1.49). Adjusted odds were highest for women with vision disabilities (aOR = 1.67, 95% CI = 1.46-1.90), followed by women with IDD (aOR = 1.53, 95% CI = 1.30-1.80), and women with physical disabilities (aOR = 1.41, 95% CI = 1.32-1.50). Women with hearing disability had the lowest adjusted odds of prolonged length of stay (aOR = 1.17, 95% CI = 1.03-1.33).

CONCLUSIONS

Prolonged length of stay did not appear to be due solely to the higher proportion of cesarean deliveries in this population. Further research is needed to better understand the reasons for prolonged length of stay among women with disabilities and develop strategies to assist women with disabilities in preparing for and recovering from childbirth.

Health care utilisation in infants and young children born to women with intellectual and developmental disabilities: A systematic review and meta-analysis

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.

Racial and Ethnic Disparities in Birth Outcomes and Labor and Delivery Charges Among Massachusetts Women With Intellectual and Developmental Disabilities

Understanding the pregnancy experiences of racial and ethnic minority women with intellectual and developmental disabilities (IDD) is critical to ensuring that policies can effectively support these women. This research analyzed data from the 1998-2013 Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system to examine the racial and ethnic disparities in birth outcomes and labor and delivery charges of U.S. women with IDD. There was significant preterm birth disparity among non-Hispanic Black women with IDD compared to their non-Hispanic White peers. There were also significant racial and ethnic differences in associated labor and delivery-related charges. Further research, examining potential mechanisms behind the observed racial and ethnic differences in labor and delivery-related charges in Massachusetts' women with IDD is needed.

Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review

BACKGROUND

While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID.

METHOD

We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country.

RESULTS

The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation.

CONCLUSIONS

Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

BACKGROUND

Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications.

OBJECTIVE

A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications.

STUDY DESIGN

Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies.

RESULTS

The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation.

CONCLUSION

Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.

Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States

Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.

Pregnancy and birth outcomes of mothers with intellectual disability and their infants: Advocacy needed to improve well-being

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.

Provision of Moderately and Highly Effective Reversible Contraception to Insured Women With Intellectual and Developmental Disabilities

OBJECTIVE

To estimate provision of moderately and highly effective reversible contraceptives to women with intellectual and developmental disabilities.

METHODS

We used data from the Massachusetts All-Payer Claims Database to identify women aged 15-44 years with and without intellectual and developmental disabilities who were continuously enrolled in a private commercial insurance plan, Medicaid, or Medicare in 2012. We calculated the percentage of women aged 15-44 years who were not medically or surgically sterile and were provided 1) highly effective, long-acting reversible contraception (LARC, the intrauterine device or subdermal implant); or 2) prescriptions for moderately effective methods (pill, patch, ring, shot, or diaphragm). Logistic regression models estimated the odds of LARC and moderately effective method provision by disability status, adjusted for age, income, and Medicaid receipt.

RESULTS

Among 915,561 women who were not medically or surgically sterile, 13,059 women (1.4%) had at least one intellectual and developmental disability. Women with intellectual and developmental disabilities were less likely to be provided LARC (2.1% vs 4.2%, P<.001, adjusted odds ratio [OR] 0.43, 95% CI 0.38-0.48, P<.001) and moderately effective methods (21.1% vs 29.9%, P<.001, adjusted OR 0.68, 95% CI 0.65-0.71, P<.001) than women without intellectual and developmental disabilities. The one exception was the progestin shot, which was provided more often to women with intellectual and developmental disabilities than women without these disabilities (14.7% vs 4.3%, P<.001). Among a subset of women who only received moderately effective methods or LARC (n=310,344), women with intellectual and developmental disability had lower odds of receiving LARC than moderately effective methods (adjusted OR 0.59, 95% CI 0.52-0.67).

CONCLUSION

The study findings raise concerns that the provision of LARC and moderately effective methods differs based on the presence of intellectual and developmental disabilities. Greater understanding is needed regarding factors that underlie lower provision of LARC in comparison with moderately effective methods, especially the progestin shot, among women with intellectual and developmental disabilities.

Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities

BACKGROUND

Women with intellectual and developmental disabilities (IDD) in the USA are bearing children at increasing rates. However, very little is known whether racial and ethnic disparities in birth outcomes and labour and delivery-related charges exist in this population. This study investigated racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with IDD.

METHODS

The study employed secondary analysis of the 2004-2011 Healthcare Cost and Utilization Project National Inpatient Sample, the largest all-payer, publicly available US inpatient healthcare database. Hierarchical mixed-effect logistic and linear regression models were used to compare the study outcomes.

RESULTS

We identified 2110 delivery-associated hospitalisations among women with IDD including 1275 among non-Hispanic White women, 527 among non-Hispanic Black women and 308 among Hispanic women. We found significant disparities in stillbirth among non-Hispanic Black and Hispanic women with IDD compared with their non-Hispanic White peers [odds ratio = 2.50, 95% confidence interval (CI): 1.16-5.28, P < 0.01 and odds ratio = 2.53, 95% CI: 1.08-5.92, P < 0.01, respectively]. There were no racial and ethnic disparities in caesarean delivery, preterm birth and small-for-gestational-age neonates among women with IDD. The average labour and delivery-related charges for non-Hispanic Black and Hispanic Women with IDD ($18 889 and $22 481, respectively) exceeded those for non-Hispanic White women with IDD ($14 886) by $4003 and $7595 or by 27% and 51%, respectively. The significant racial and ethnic differences in charges persisted even after controlling for a range of individual-level and institutional-level characteristics and were 6% (ln(β) = 0.06, 95% CI: 0.01-0.11, P < 0.05) and 9% (ln(β) = 0.09, 95% CI: 0.03-0.14, P < 0.01) higher for non-Hispanic Black and Hispanic Women with IDD compared with non-Hispanic White women with IDD.

CONCLUSIONS

Our findings highlight the need for an integrated approach to the delivery of comprehensive perinatal services for racial and ethnic minority women with IDD to reduce their risk of having a stillbirth. Additionally, further research is needed to examine the causes of racial and ethnic disparities in hospital charges for labour and delivery admission among women with IDD and ascertain whether price discrimination exists based on patients' racial or ethnic identities.

Intimate Partner Violence among Women with Disabilities in Uganda

Violence against women with disabilities is pervasive, yet a paucity of research examines intimate partner violence (IPV) experienced by women with disabilities in low- and middle-income countries. The purpose of this study is to document the prevalence and consequences of IPV exposure among Ugandan women with disabilities. Cross sectional data from the 2011 and 2016 Uganda Demographic and Health Surveys (UDHS) were used to study married and/or partnered women aged 15⁻49 who answered specific questions about lifetime intimate partner violence (N = 8592). Univariate and multivariate logistic regression models were used to investigate the relationship between disability, IPV, and indicators of maternal and child health. Compared to women without disabilities, women with disabilities were more likely to experience lifetime physical violence (odds ratio (OR) 1.4, p < 0.01), sexual violence (OR = 1.7, p < 0.01), and emotional abuse (1.4, p < 0.01) after controlling for sociodemographic and household characteristics. Study findings suggest that women with disabilities in Uganda may experience increased risk for IPV compared to women without disabilities, with concomitant risks to their health and the survival of their infants. Further research examining the prevalence and correlates of IPV in low- and middle-income countries is needed to address the needs and rights of women with disabilities.

Differences in Prenatal Care by Presence and Type of Maternal Disability

INTRODUCTION

Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities.

METHODS

This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits.

RESULTS

Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits.

CONCLUSIONS

There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations.

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

Background

An emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.

Methods

We analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.

Results

We identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.

Conclusion

These findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

Pregnancy course, infant outcomes, rehospitalization, and mortality among women with intellectual disability

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.

"I Didn't Need People's Negative Thoughts": Women With Intellectual and Developmental Disabilities Reporting Attitudes Toward Their Pregnancy

Background

Since the illegalization of involuntary sterilization of persons with intellectual and developmental disabilities, there has been an increase in childbearing in this population. However, women with intellectual and developmental disabilities continue to experience prejudicial attitudes toward their pregnancies.

Objective

To analyze the experiences of women with intellectual and developmental disabilities regarding their perceptions of support persons’ attitudes toward their pregnancies.

Methods

Three case studies derived from grounded theory research exploring perinatal social support received by women with intellectual and developmental disabilities. Using inductive content analysis, we further analyzed the perceptions of women with intellectual and developmental disabilities regarding support persons’ attitudes toward their pregnancies. Findings: The nature of interactions with support persons and women’s characteristics, such as help-seeking behaviors, disability, mental illness, and age, influenced support persons’ attitudes toward childbearing. Women preferred support from caregivers perceived as nonjudgmental and tended to restrict contact with persons perceived as prejudicial. However, some attitudes improved following positive interactions with the women. The relationship between support persons’ attitudes and the women’s help-seeking behaviors is thus complex.

Conclusions

Education of families and medical and social services practitioners and opportunities for positive contact should be further explored. Caseworkers of women with intellectual and developmental disabilities may have invaluable roles in facilitating positive interactions between women with intellectual and developmental disabilities and caregivers.

Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study

Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002-2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1-42, 43-90, and 1-365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1-42, 43-90, and 91-365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.

Antenatal Hospitalization Among U.S. Women With Intellectual and Developmental Disabilities: A Retrospective Cohort Study

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.

Addressing sexual and reproductive health in adolescents and young adults with intellectual and developmental disabilities

PURPOSE OF REVIEW

This review provides support for promoting the sexual health of adolescents and young adults with developmental disabilities, and particularly those with intellectual disabilities. It offers guidance for pediatricians on incorporating counseling on sexuality and reproductive healthcare, socially appropriate behavior, and sexual abuse prevention for adolescents and young adults with developmental disabilities into healthcare visits. Additionally, it provides resources for developmentally appropriate sexuality education in the home and community to allow access to the comprehensive sexual and reproductive healthcare patients deserve.

RECENT FINDINGS

Adolescents and young adults with developmental disabilities often do not receive developmentally appropriate sexual health education, and this is associated with poor sexual health outcomes and increased rates of sexual abuse in this population.

SUMMARY

Pediatricians should discuss sexual health with all patients, including adolescents and young adults with developmental disabilities. They are well suited to provide sexual health education and inform families about appropriate sexual health resources.

Provision of Reproductive Healthcare to Women with Disabilities: A Survey of Obstetrician-Gynecologists' Training, Practices, and Perceived Barriers

Purpose: The purpose of this study was to document current awareness, attitudes, and training regarding the care of women with disabilities by obstetrician-gynecologists (ob-gyns) and explore barriers that may explain observed discrepancies in care. Methods: One thousand ob-gyns, including 500 members of the Collaborative Ambulatory Research Network (CARN), were surveyed on practice accessibility, training, awareness, barriers, beliefs, comfort, challenges, practices, contraceptive counseling, and preconception/pregnancy counseling. Results: CARN, 49.0%, and non-CARN, 19.4%, members completed the survey for an overall response rate of 33.9%. Most respondents indicated feeling "somewhat" (57.5%) or "very" (21.9%) aware of the special healthcare needs of women with disabilities. Only 17.2%, however, received any information or training on the provision of healthcare to women with disabilities. Eighty-one percent agreed somewhat or strongly that women with disabilities are less likely to receive comprehensive reproductive healthcare. Respondents who provided contraceptive counseling (94.3%) initiated it with women of reproductive age who did not have a disability more frequently than those who had a disability. Finally, only 19.3% felt "definitely" adequately equipped to manage the pregnancies of women with disabilities. Conclusion: Women with disabilities require reproductive healthcare no less than women without disabilities; however, the evidence consistently identifies disparities. This study suggests that while ob-gyn providers are aware of these issues, they lack adequate training and resources to provide equal care.

Antenatal Hospital Utilization Among Women at Risk for Disability

BACKGROUND

Little is known about the effect of potentially disabling health conditions on healthcare utilization during pregnancy. Using hospital discharge data, we identified women at risk for disability and evaluated antenatal hospital utilization, including emergency department (ED), observational stay (OS), and inpatient (IP) visits, by underlying health condition.

MATERIALS AND METHODS

Massachusetts Pregnancy to Early Life Longitudinal data system linked 2007-2009 birth certificates to 2006-2009 discharges. Access Risk Classification System categorized ICD-9-CM/Current Procedural Terminology codes recorded at delivery into disability risk groups (no/low vs. medium/high). Women were further categorized based on delivery diagnoses. Cox models evaluated the association between disability risk and utilization. Utilization by prenatal care and visit reason was examined.

RESULTS

Of 221,867 women, 4.0% were at medium/high risk of disability. Mental illness (26.9%) and circulatory system (25.2%) diagnoses were most common. More than 2% had comorbid mental/physical conditions. Women at risk for disability were more likely than women not at risk to have an antenatal ED (37.1% vs. 25.0%), OS (19.1% vs. 13.1%), or nondelivery IP visit (11.5% vs. 4.0%) (p ≤ 0.001 for each). Utilization varied by diagnosis. In adjusted analyses, women with two or more physical conditions had highest rate of ED visit (hazard ratio [HR] = 2.3, 95% confidence interval 1.8-2.8) and OS/IP visit (HR = 2.9, 95% 2.3-3.6) compared with women not at risk. Inadequate prenatal care was associated with increased utilization across all disability risk groups. ED visits for mental illness were high across groups.

CONCLUSIONS

Disability risk identified in discharge data is associated with elevated antenatal hospital utilization. Utilization varies by underlying diagnosis.

Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review

Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study's purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.