Improved preconception care for disabled women needed

Pregnant women with preexisting disabilities have a significantly higher risk of severe maternal morbidity and mortality, according to researchers.

Their population-based cohort study found that the adjusted relative risk of severe maternal morbidity or death was higher among women with physical, sensory, and intellectual/developmental disabilities, as well as women with two or more disabilities.

The study from Hilary K. Brown, PhD, Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, and colleagues, was published in JAMA Network Open.

While rare in industrialized countries, maternal mortality rates since 1990 have increased in both the U.S. (from 10.0 to 17.3 deaths per 100,000 births) and Canada (7.6 to 11.0 deaths per 100,000 births). The same holds true for severe morbidity, which the authors defined either by disease-specific criteria, such as eclampsia; interventions, such as blood transfusion; or organ system dysfunction, such as heart failure.

“Studies showing that chronic conditions, such as cardiovascular disease and diabetes, are among the leading causes of such morbidity and mortality have led to significant preventive efforts for women with these conditions, including better preconception and perinatal care,” Brown and colleagues observed. “However, the association of maternal disability with these outcomes is relatively unknown.”

In this study, which involved a population-based cohort in Ontario, Brown and colleagues wanted to compare maternal morbidity and mortality outcomes in women with physical, sensory, intellectual/developmental, and multiple disabilities compared to women without them.

The women in this study (ages 15 to 49) were eligible for Ontario’s health insurance plan and included those with and without disabilities who had a single live delivery or stillbirth between 2003 and 2018. The study cohort included 144,972 women with physical disabilities, 45,259 women with sensory disabilities, 2,227 women with intellectual/ developmental disabilities, 8,883 women with two or more disabilities, and 1,601,363 women without disabilities.

The main outcomes of the study were severe maternal morbidity — a composite of 40 diagnostic and procedural indicators — or all-cause maternal mortality, up to 42 days postpartum, with relative risks adjusted for maternal age, parity, income, location, chronic medical conditions, mental illness, and substance use disorders.

Brown and colleagues found the adjusted relative risk of severe maternal morbidity or death was 29% higher among women with a physical disability, 14% higher among women with a sensory disability, 57% higher among women with an intellectual/ developmental disability, and 74% higher among women with two or more disabilities.

In addition, the authors found:

  • Women with sensory disabilities, intellectual/developmental disabilities, and multiple disabilities were younger, and those with physical disabilities were slightly older, than women with no disabilities.
  • Women with intellectual/developmental disabilities were more likely to live in low-income neighborhoods.
  • Women with sensory and multiple disabilities were more likely to have diabetes, and those with multiple disabilities were more likely to have chronic hypertension or cardiovascular disease.
  • Women with physical and multiple disabilities were more likely to have stable chronic conditions.
  • Women with intellectual/developmental and multiple disabilities were more likely to have a substance use disorder.

“Our results have implications for development of supports to assist women with disabilities, including improved preconception care to address social and health risks and comprehensive care across pregnancy and the extended postpartum period,” Brown and colleagues concluded.

In a commentary accompanying the study, Elizabeth Wall-Wieler, PhD, Department of Community Health Sciences, Max Rady College of Medicine, Winnipeg, Manitoba, noted that while Brown and colleagues were unable to adjust for race/ethnicity because of the limitations of the data, “the prevalence of both disability and [severe maternal morbidity] are higher among racial/ethnic minorities.” She suggested that future research should examine the interconnection of race/ethnicity, poverty, and the risk of severe maternal morbidity.

Wall-Wieler also pointed out that Brown and colleagues did not specify whether efforts to improve preconception care for disabled women means giving them access to the same preconception programs as women without disabilities, or whether specific programs need to be developed to address their specific needs.

“Understanding the scope of the issue is an important first step,” she wrote. “Future work should focus on how to best address the observed disparities and improve reproductive outcomes for women with disabilities.”

  1. Women with preexisting disabilities have a higher risk of experiencing severe maternal morbidity or mortality.

  2. The researchers suggest that efforts are needed to improve preconceptions and perinatal care for women with disabilities.

Michael Bassett, Contributing Writer, BreakingMED™

The study authors had no relevant relationships to disclose.

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Topic ID: 83,41,585,730,41,192,925