Women With Disabilities at Higher Risk for Poor Maternal Outcomes

Risk for severe maternal morbidities and maternal mortality higher for pregnant women who have disabilities, regardless of disability type

THURSDAY, Dec. 23, 2021 (HealthDay News) — Pregnant women with physical, intellectual, and sensory disability are at higher risk for adverse maternal outcomes, according to a study published online Dec. 15 in JAMA Network Open.

Jessica L. Gleason, Ph.D., from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, and colleagues evaluated the risk for adverse maternal outcomes, including severe maternal morbidities (SMMs) and mortality, among women with and without disabilities. The analysis included medical chart review for 223,385 women (0.9 percent with disabilities) delivering between January 2002 and January 2008 at 12 U.S. clinical sites.

The researchers found that compared with women with no disability, women with disabilities had a higher risk for 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), as well as a higher risk for individual SMMs, including severe preeclampsia/eclampsia (aRR, 2.15), hemorrhage (aRR, 1.27), and fever (aRR, 1.32). The highest risks were observed for thromboembolism (aRR, 6.08), cardiovascular events (aRR, 4.02), and infection (aRR, 2.69). There was also a higher risk for interventions among women with any disability, including oxytocin augmentation, operative vaginal delivery, and cesarean delivery (aRR, 1.33), with the cesarean indication less likely to be medically indicated (aRR, 0.79).

“Increased risk may be the result of a combination of independent risk factors, including the higher rate of obstetric intervention via cesarean delivery, under-recognition of women with disabilities as a population with higher risk pregnancies, and lack of health care practitioner knowledge or comfort in managing pregnancies among women with disabilities,” the authors write.