Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study

Tarasoff, Lesley A.; Lunsky, Yona; Chen, Simon; Guttmann, Astrid; Havercamp, Susan M.; Parish, Susan L.; Vigod, Simone N.; Carty, Adele; Brown, Hilary K.

doi:10.1089/jwh.2019.8273

Cited by 32 publications

(26 citation statements)

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“…Of particular relevance to the findings of the study by Horner-Johnson et al is our finding that, compared with women without disabilities, pregnancy rates were lower overall but higher among teenagers (aged 15-19 years) [1]. My colleagues and I also found that women with disabilities of reproductive age (15-44 years) experience many health disparities, including higher rates of substance use disorders and assault, than those without disabilities [4]. These and other health disparities were particularly pronounced among reproductive age women with IDD.…”

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confidence: 55%

“…Those with IDD were the youngest and most socioeconomically marginalized group.The findings from our Ontario-based research and from the study by Horner-Johnson et al in this issue of the Journal of Adolescent Health, as well as their research documenting high rates of unintended pregnancy among women with disabilities [5], underscore the need for a life course approach concerning the sexual and reproductive health of people with disabilities. For those with disabilities, sexual and reproductive health education should start early and include discussions about sexuality, sexual behavior, reproductive life plans (including the social, psychological, and physiological impact of pregnancy), consent, and healthy relationships [4].…”

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confidence: 99%

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A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

Tarasoff

2021

Journal of Adolescent Health

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The study by Horner-Johnson et al. in this issue of the Journal of Adolescent Health concerning the sexual health experiences of high school students with disabilities is an important contribution to the literature, particularly in light of a growing body of literature on the reproductive and perinatal health of women with disabilities. Learning about the sexual experiences of youth with disabilities may help us understand their later sexual and reproductive health experiences and identify ways in which we might work to mitigate adverse outcomes (e.g., unintended pregnancies, sexual violence, sexually transmitted infections).Pregnancy is not uncommon among women with disabilities; recent studies conducted in both the U.S. and Canada have found that rates of pregnancy are slightly lower among those with physical disabilities and sensory disabilities than in those without disabilities, but the difference is small [1e3]. From health administrative data in Ontario, Canada, my colleagues and I found that between 2003 and 2018, pregnancy rates slightly decreased among those without disabilities, increased among those with sensory disabilities and multiple disabilities, and stayed about the same for those with physical disabilities and intellectual and/or developmental disabilities (IDDs) [1]. Of particular relevance to the findings of the study by Horner-Johnson et al. is our finding that, compared with women without disabilities, pregnancy rates were lower overall but higher among teenagers (aged 15-19 years) [1]. My colleagues and I also found that women with disabilities of reproductive age (15-44 years) experience many health disparities, including higher rates of substance use disorders and assault, than those without disabilities [4]. These and other health disparities were particularly pronounced among reproductive age women with IDD. Those with IDD were the youngest and most socioeconomically marginalized group.The findings from our Ontario-based research and from the study by Horner-Johnson et al. in this issue of the Journal of Adolescent Health, as well as their research documenting high rates of unintended pregnancy among women with disabilities [5], underscore the need for a life course approach concerning the sexual and reproductive health of people with disabilities. For those with disabilities, sexual and reproductive health education should start early and include discussions about sexuality, sexual behavior, reproductive life plans (including the social, psychological, and physiological impact of pregnancy), consent, and healthy relationships [4].

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confidence: 55%

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confidence: 99%

A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

Tarasoff

2021

Journal of Adolescent Health

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“…Studies of preconception health among women with disabilities have found greater prevalence of tobacco use, obesity, chronic conditions such as asthma and diabetes, experiences of violence and inadequate social support as compared to women without disabilities. 35,40,41 Such differences are likely driven at least in part by systemic ableism and structural barriers contributing to unemployment, poverty and limited access to health-promoting venues, relationships and resources among those with disabilities. 42,43 Efforts are needed to identify and address potentially preventable health conditions and systemic and social risk factors that may contribute to increased SMM risk for women with disabilities.…”

Section: Discussionmentioning

confidence: 99%

“…Further research is needed to elucidate additional risk factors and underlying causes of SMM among women with disabilities. Studies of preconception health among women with disabilities have found greater prevalence of tobacco use, obesity, chronic conditions such as asthma and diabetes, experiences of violence and inadequate social support as compared to women without disabilities 35,40,41 . Such differences are likely driven at least in part by systemic ableism and structural barriers contributing to unemployment, poverty and limited access to health‐promoting venues, relationships and resources among those with disabilities 42,43 .…”

Section: Discussionmentioning

confidence: 99%

Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities

Horner‐Johnson

Garg

Darney

et al. 2022

Paediatric Perinatal Epid

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Background Little is known about severe maternal morbidity (SMM) among women with disabilities. Objective We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities. Methods We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23–42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate‐adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes. Results Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities). Conclusion As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.

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“…3 More than 12% of reproductive-aged women have a physical, sensory, or intellectual disability, 4 and US Medical Expenditure Panel Survey data show that women with disabilities report similar past-year pregnancy rates as those without disabilities. 5 These data demonstrate a need for information on maternal outcomes among women with disabilities to inform clinical practice, particularly given that women with disabilities experience significant preconception social, health, and health care disparities, such as elevated rates of poverty, chronic illness, depression and anxiety, and barriers accessing health care 4 -all known risk factors for adverse maternal outcomes. Indeed, growing evidence shows elevated rates of common complications of pregnancy, such as gestational diabetes, gestational hypertension, and cesarean delivery, among women with disabilities.…”

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confidence: 99%

Disparities in Severe Maternal Morbidity and Mortality—A Call for Inclusion of Disability in Obstetric Research and Health Care Professional Education

Brown

2021

JAMA Netw Open

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Despite advances in medicine, rates of adverse maternal outcomes, such as severe maternal morbidity and maternal mortality, are increasing in high-income countries. 1 Of particular concern is the observation that such increases include widening disparities among underserved and minoritized populations. 1 Elsewhere in JAMA Network Open, Gleason et al 2 add to the literature on maternal health disparities by using data from the Consortium on Safe Labor to examine the risks of obstetric interventions and adverse maternal outcomes, including severe maternal morbidity and maternal mortality, among 2142 women with a physical, sensory, or intellectual disability compared with 221 252 women without disabilities. They found women with disabilities were at elevated risk of a range of obstetric interventions, including cesarean delivery (adjusted relative risk [aRR], 1.33; 95%

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Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study

Cited by 32 publications

References 44 publications

A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

A Call for Comprehensive, Disability- and LGBTQ-Inclusive Sexual and Reproductive Health Education

Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities

Disparities in Severe Maternal Morbidity and Mortality—A Call for Inclusion of Disability in Obstetric Research and Health Care Professional Education

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