Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid

Abstract

Background Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007–2016. Methods Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. Results Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. Conclusions Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

“…We relied on the birth record for demographic variables and more detailed phenotypic, health history, and structural determinant data are needed to identify causal mechanisms. In our data, mothers with IDD were at greater risk of gestational diabetes, gestational hypertension, and caesarean delivery compared to mothers without IDD 21 . Maternal health care and pregnancy complications may act as mediators on the pathway from maternal IDD to birth outcomes; 40,41 a more formal mediation analysis with data that can meet the assumptions of no unmeasured confounding 42 may be needed to determine what proportion of increased prevalence can be attributable to maternal morbidity.…”

“…More data on pregnancy planning and pregnancy‐related health‐service usage in women with IDD are needed to explore this potential mechanism. Mothers with IDD are at greater risk of pregnancy complications compared to peers, 21 which may be a causal factor in the development of poor infant outcomes 54 . Compared to women without IDD, women with IDD are also at greater risk of having co‐occurring conditions such as anxiety, depression, epilepsy, and cardiovascular disease 20 and may be taking medication for those indications.…”

“…We used ICD codes for IDD identified from previous studies 5,18‐20 and these codes are presented in Table . In previous analyses with these data, we have examined the impact of stricter classification of IDD (more than one claim for IDD, more than one claim for IDD on different days) and found no differences in demographics or maternal outcomes between IDD classifications 21 . Therefore, we categorised IDD as any one claim of IDD in the Medicaid record.…”

Reproductive and pregnancy health care for women with intellectual and developmental disabilities: A scoping review

“…There were 17 studies that examined prenatal care for women with intellectual and developmental disabilities (Table 3). While a high percentage of women with intellectual and developmental disabilities received prenatal care (Höglund et al, 2012; Pohl et al, 2020; Rubenstein et al, 2020), uptake of prenatal care was significantly lower and received later than women without intellectual and developmental disabilities (Horner‐Johnson, 2019; Malouf, Henderson, et al, 2017; Mitra et al, 2015; Mueller et al, 2019; Redshaw et al, 2013). While less likely to have regular prenatal visits (Horner‐Johnson, 2019), women with intellectual and developmental disabilities were more likely to have emergency department visits during pregnancy compared to peers (Mitra et al, 2018).…”

“…Once pregnant, women with intellectual and developmental disabilities are more likely to experience negative perinatal, delivery, and postpartum health outcomes, including gestational diabetes, hypertensive disorders of pregnancy, haemorrhage, emergency department visits, and caesarean section compared to peers (Tarasoff, Murtaza, et al, 2020). Additionally, newborns of women with intellectual and developmental disabilities are at increased risk of neonatal morbidity—including low birthweight, preterm birth, neonatal intensive care unit (NICU) admission and neonatal mortality (Rubenstein et al, 2020; Tarasoff, Ravindran, et al, 2020). The specific mechanisms that lead to increased risk of morbidity and mortality for women with intellectual and developmental disabilities and their newborns are less understood.…”