Risk for neonatal complications elevated for mothers with disabilities
The risk for neonatal complications is elevated for mothers with disabilities, according to the results of a Canadian study published in Pediatrics.
Hilary K. Brown, PhD, an assistant professor in the department of health and society at the University of Toronto Scarborough, and colleagues assessed births recorded over a 15-year period in Ontario and found a “mild to moderate elevated risk for complications among newborns of women with disabilities.”
Brown told Healio that the study was prompted by a lack of information on pregnant women with disabilities.
“There's a large body of research that shows that women with disabilities experience a lot of barriers accessing health care,” Brown said. “We also know that they're disproportionately affected by social determinants of health, like poverty and barriers to education and that sort of thing, but not a lot of research previously has looked specifically at reproductive and perinatal outcomes.”
Brown said there are “a lot of reasons” why this is studied so little.
“There's a lot of assumptions around sexuality and disability, and how often people with disabilities actually experience pregnancy,” Brown said. “But we had done some work looking at pregnancy rates in this population and showed that pregnancy rates are increasing in people with disabilities.”
about one in eight pregnancies are carried by mothers with a physical, sensory, intellectual or developmental disability.
“And so the next question was, What are their pregnancy-related outcomes and health care experiences?” Brown said.
Brown and colleagues studied health administrative data on Ontario residents from 2003 to 2018, searching pregnancy cases for a physical (144,187), sensory (44,988) or intellectual or developmental (2,207) disability-related diagnoses and their health care records. They compared the records with those of pregnant people without disabilities and looked at the outcomes of their newborns.
The researchers hypothesized that women with disabilities would have higher rates of newborn complications “because of what we know about the barriers that they experienced accessing health care and these social determinants of health,” according to Brown.
“We know that those complications are driven by things like barriers [to] accessing prenatal care, as well as things like poverty,” Brown said. “We did observe that risks remained elevated, even after accounting for things like poverty.”
According to the data, there were increases in preterm birth, small gestational birth weight, NICU admission and neonatal morbidity.
The researchers found in their qualitative research of parents with disabilities that wheelchair-bound mothers could not enter the NICU to see their infants.
“If we're seeing higher rates of NICU admissions in this population, let's make sure that those spaces are accessible to women with disabilities,” Brown said. “Underlying all these things, there's a real need for better education of health care providers around disability and pregnancy, because a lot of people aren't thinking about disability when it comes to caring for pregnant populations. There's a real need to improve disability competency and just yet provide health care providers with the resources that they need to get great care.”
In an accompanying commentary, Kathleen E. Hannan, MD, Sunah S. Hwang, MD, MPH, PhD, and Stephanie L. Bourque, MD, said the study “highlights the need for ongoing research to identify the barriers and facilitators to improve birth outcomes among women with disabilities.”
“Moreover, further work is needed to identify and measure the potential additive or exponential impact of disabilities in the birthing population when combined with other known perinatal risk factors,” they wrote. “Adapting already existing programs for the perinatal population, as well as developing targeted new programs to meet the unique needs of pregnant women with disabilities, will likely be needed.”
“In all of the work that we're doing on this topic, we really want to emphasize the need for these results to be used to provide better quality care and more positive experiences for these moms and not to kind of further medicalize their experiences,” Brown said. “It really is about providing accessible tailored care to a diverse group of moms.”
References:
Brown HK, et al. Pediatrics. 2022;doi:10.1542/peds.2021-055318.
Hannan K, et al. Pediatrics. 2022;doi:10.1542/peds.2021-055318.
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