Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study

Abstract

Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002-2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1-42, 43-90, and 1-365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1-42, 43-90, and 91-365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

“…Twenty-three studies, representing 8,514,356 women in 19 distinct cohorts (including 1 US study that examined 4 states separately), 50 met our inclusion criteria and were included in the qualitative synthesis. Three articles from Canada [44][45][46] and 9 from the United States representing 3 different investigations (2 using California administrative data, 49,53 5 using the Pregnancy to Early Life Longitudinal Data System, 47,48,56,58,59 and 2 using the Pregnancy Risk Assessment Monitoring System for Rhode Island 57,61 ) used the same data sources and had fully or partially overlapping samples and study periods. Table 3 describes the studies' characteristics.…”

“…Studies examined the impact of maternal disability overall (n ¼ 10) 47e50, 53,54,57,61,64,66 or physical (n ¼ 1), 60 sensory (n ¼ 2), 62,65 or intellectual and developmental disabilities separately (n ¼ 10). [44][45][46]51,52,55,56,58,59,63 Of the studies that examined the impact of maternal disability overall, 4 compared an any-disability group with a nodisability referent group, 50,57,61,66 and 6 also reported findings broken down by disability type. 47e49, 53,54,64 Six studies included women with mental health disorders within their any-disability group.…”

“…ajog.org 8). 46,47,50,52,54,58,64,65 Studies varied with respect to their control for confounding variables; 6 studies did not control for confounders at all. 51,55e57,61,66 Risk of bias of included studies Table 1 describes the quality of included studies.…”

“…With regard to selection bias, most studies were population based and had good generalizability (n ¼ 15). 44e49,51e53, 56,58,59,62,63,65 However, 2 retrospective cohort studies relied on low-income Medicaid 50 or tertiary care center samples. 60 Of the 2 prospective cohort and 5 cross-sectional studies, 2 had a response rates <80% 54,57 and 4 did not report response rates.…”

Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study

“…A recent population-based cohort study examining postpartum hospital admission among US women found that women with IDD had markedly elevated rates of hospital admission compared with women without IDD throughout the first year post partum 16. Another population-based study reported an increased risk for emergency department (ED) visits and hospital admission, particularly for visits related to psychiatric concerns, within 1–42 days of delivery among Canadian women with IDD 6.…”