Severe maternal morbidity risk high for women with vision, physical disabilities

Key takeaways:

• Women with disabilities had higher severe maternal morbidity rates per 10,000 deliveries vs. women without.
• Highest severe maternal morbidity rates were observed among women with vision or physical disabilities.

Women with vs. without disabilities have higher severe maternal morbidity risk during childbirth, with the highest risks observed for women with vision or physical disabilities, researchers reported in O&G Open.

“A better understanding of severe maternal morbidity among women with different disabilities will inform the development of tailored risk assessments, counseling and care coordination approaches across preconception, prenatal and postpartum periods to address the unique needs of patients with specific types of disabilities,” Ilhom Akobirshoev, PhD, director of research at the Lurie Institute for Disability Policy and research scientist at the Heller School for Social Policy and Management at Brandeis University, and colleagues wrote. “As such, this work is relevant to health care professionals, payors, policymakers and other stakeholders seeking to improve care quality and reduce inequities.”

Akobirshoev and colleagues conducted a retrospective cohort analysis evaluating data from 4,331,457 delivery hospitalizations from the 2016 to 2021 Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. Researchers estimated severe maternal morbidity for women with and without disabilities who gave birth.

Primary outcome was severe maternal morbidity identified by 21 CDC indicators.

Overall, 3% of women had a disability. Of these women, 3,498 had vision disabilities, 3,833 were deaf or hard of hearing, 46,903 had physical disabilities, 3,206 had intellectual and developmental disabilities, 65,592 had psychiatric disabilities and 5,381 had multiple disabilities.

Women with disabilities had higher severe maternal morbidity rates of 396 per 10,000 deliveries while women without disabilities had lower rates of 177 per 10,000 deliveries. In addition, women with vs. without disabilities had a higher risk for one or more severe maternal morbidity indicators (adjusted RR = 1.86; 95% CI, 1.8-1.91).

Severe maternal morbidity risk varied based on disability type, with the highest risks among women with vision disabilities (aRR = 3.02; 95% CI, 2.7-3.38) and physical disabilities (aRR = 2.44; 95% CI, 2.34-2.55).

Researchers also observed higher risks for other medical complications (aRR = 6.39; 95% CI, 5.6-7.29) and obstetric complications (aRR = 4.55; 95% CI, 4.16-4.96), including respiratory complications (aRR = 3.43; 95% CI, 3.15-3.72), CV complications (aRR = 2.72; 95% CI, 2.44-3.03), acute renal failure (aRR = 2.25; 95% CI, 2.06-2.46), sepsis (aRR = 2.08; 95% CI, 1.86-2.33) and bleeding complications (aRR = 1.68; 95% CI, 1.56-1.8) among women with vs. without disabilities.

“These findings underscore the urgent need to address the unique needs of this vulnerable population in efforts to reduce maternal morbidity and mortality in the United States,” the researchers wrote. “Health care professionals and policymakers must prioritize disability-competent care when developing interventions to improve maternal outcomes.”