Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States

Abstract

Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.

Pregnancy‐related outcomes among women with physical disabilities: A systematic review

“…Of the 16 included studies, eight were cross‐sectional 13,14,19‐24 and eight were retrospective cohorts 15,17,25‐30 . Studies were conducted in the United States ( n = 13) 13,15,17,19‐22,25‐30 and the United Kingdom (UK) ( n = 3) 14,23,24 and based on nine different data sources including: Massachusetts Pregnancy to Early Life Longitudinal data system (PELL, n = 3) 25‐27 ; California birth certificate and hospital discharge records ( n = 3) 15,17,29 ; Pregnancy Risk Assessment Monitoring System (PRAMS, n = 3) 13,21,22 ; and the UK National Health Service Care Quality Commission Survey ( n = 2) 14,23 . Definitions of physical disabilities varied.…”

“…Eight studies defined physical disabilities based on hospital records, databases, or diagnosis codes (eg International Classification of Diseases, ICD, codes): One study examined spinal cord‐related physical disabilities (eg spinal cord injury, spina bifida, paralysis) 28 and seven studies examined any diagnosed conditions related to physical disabilities (“diagnosed physical disabilities”) or grouped by body system (eg musculoskeletal, circulatory, nervous systems) 15,17,25‐27,29,30 . Two studies defined physical disability based on self‐report (“self‐reported physical disabilities”) 14,19 . Lastly, six studies relied on self‐reported disabilities related to long‐standing physical conditions, illnesses, or difficulties with daily life activities, including disabilities related to sensory, intellectual, and mental/emotional health (“any self‐reported disabilities”) 13,20‐24 .…”

“…Eight studies 15,17,25‐30 were rated as fair quality and eight studies 13,14,19‐24 were rated as poor quality. Studies rated as fair quality were retrospective cohorts; assessed disability status using diagnostic codes for medical conditions associated with disability risk; and assessed outcomes using birth certificate and hospital discharge data.…”

“…Nine studies examined labour and delivery outcomes including miscarriage ( n = 2), 19,20 abortion ( n = 1), 20 premature rupture of membranes ( n = 2), 21,28 preterm labour or birth ( n = 5), 13,21,24,28,30 caesarean delivery ( n = 7), 14,17,21,23,25,28,30 labour complications ( n = 3, eg, malpresentation, lacerations), 23,28,30 or number of days hospitalised after delivery ( n = 5) 14,21,23,25,28 …”

“…Dissanayake et al used the US National Survey of Family Growth, 2011–2015, to identify women with self‐reported physical disabilities and reported miscarriages within the previous five years 19 . Compared to women with no disabilities, women with self‐reported physical disability were two times more likely to have experienced at least one miscarriage (aOR 1.99, 95% CI 1.07, 3.71).…”