Intellectual, developmental disabilities increase maternal, obstetric risks

Key takeaways:

• Women with vs. without intellectual and developmental disabilities have higher risks for worse obstetric and maternal outcomes.
• Postpartum anxiety and depression risk was higher for women with autism.

Women with vs. without intellectual and developmental disabilities have greater risks for stillbirth and other adverse obstetric, mental health and medical outcomes, according to findings published in JAMA Network Open.

“Characteristics associated with intellectual and developmental disabilities, including social and communication differences and sensory sensitivities, may increase vulnerability to the stressors and changes experienced physically and mentally throughout the perinatal period, emphasizing the need for services and supports to address increased risk,” Lindsay Shea, DrPH, director of the Policy and Analytics Center at the A.J. Drexel Autism Institute at Drexel University in Philadelphia, and colleagues wrote. “Subgroups of individuals with intellectual and developmental disabilities have reported sensory overload, a lack of control, and challenges in effectively engaging with medical care professionals, including obstetrician-gynecologists.”

Shea and colleagues conducted a retrospective cohort study using national Medicaid claims data from 2008 to 2019 of 55,440 birthing women with and 438,557 birthing women without intellectual and developmental disabilities. Women were categorized as having intellectual and developmental disabilities based on at least one inpatient or two other claims associated with an autism diagnosis, intellectual disability diagnosis or both. Researchers compared perinatal outcomes and estimated the probability of anxiety and depression across groups.

Overall, 13,586 of women with the disabilities had autism. Women with intellectual and developmental disabilities had a younger mean age of 24.9 years at first delivery. Women without such disabilities had a mean age of 26.4 years at first delivery.

Compared with mothers without, those with intellectual and developmental disabilities had a lower prevalence of live births (66.6% vs. 76.7%; adjusted OR = 0.83; 95% CI, 0.81-0.85) and higher rates of obstetric and accompanying physical and mental health conditions:

• gestational diabetes (10.3% vs. 9.9%; aOR = 1.13; 95% CI, 1.09-1.17);
• gestational hypertension (8.7% vs. 6.1%; aOR = 1.15; 95% CI, 1.1-1.2);
• preeclampsia (6.1% vs. 4.4%; aOR = 1.17; 95% CI, 1.12-1.23);
• heart failure (1.4% vs. 0.4%; aOR = 1.84; 95% CI, 1.63-2.07);
• hyperlipidemia (5.3% vs. 1.7%; aOR = 2.17; 95% CI, 2.04-2.32);
• ischemic heart disease (1.5% vs. 0.4%; aOR = 1.96; 95% CI, 1.74-2.21);
• obesity (16.3% vs. 7.4%; aOR = 1.55; 95% CI, 1.5-1.6);
• anxiety disorders (27.9% vs. 6.5%; aOR = 2.94; 95% CI, 2.85-3.03);
• depressive disorders (32.1% vs. 7.5%; aOR = 3.26; 95% CI, 3.17-3.36); and
• PTSD (9.5% vs. 1.2%; aOR = 4.08; 95% CI, 3.86-4.31).

Researchers observed a significantly higher probability of postpartum anxiety (aHR = 3.2; 95% CI, 2.9-3.4) and postpartum depression (aHR = 2.4; 95% CI, 2.3-2.6) for mothers with autism compared with all women without autism.

According to the researchers, these findings highlight a need to tailor reproductive health education, perinatal care and delivery services for women with intellectual and developmental disabilities to ensure they receive comprehensive and targeted support.

“Designing and implementing policies aligned with and guided by the needs of people with intellectual and developmental disabilities can lead to reductions in maternal health disparities. Advances to this objective may be accelerated by adapting current clinical guidelines and procedures associated with the specific needs and experiences of people with intellectual and developmental disabilities,” the researchers wrote. “The effectiveness of new Medicaid policies in improving the health profile of birthing people with intellectual and developmental disabilities, such as the postpartum coverage extension, should be assessed by tracking potential variation in outcomes after implementation of these policies.”