Pregnancy outcome in women with cerebral palsy: A nationwide population‐based cohort study

Sundelin, Heléne E.K.; Stephansson, Olof; Johansson, Stefan; Ludvigsson, Jonas F.

doi:10.1111/aogs.13773

Cited by 10 publications

(12 citation statements)

References 34 publications

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“…Based on previous analysis, autistic women in our sample are more educated and likely to be married as compared to other IDD groups 10 and this socioeconomic advantage compared to other IDD groups may lead to relatively better outcomes. Our findings for infants of mothers with intellectual disability or cerebral palsy were aligned with past work on those specific conditions 43,44 . Consistently poor outcomes across IDD‐type may indicate that these women face some similar social and health disparities.…”

Section: Resultssupporting

confidence: 78%

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

Rubenstein

Ehrenthal

Mallinson

et al. 2021

Paediatric Perinatal Epid

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Background Women with intellectual and developmental disabilities (IDD) face increased risk of adverse maternal pregnancy outcomes, yet less is known about infant outcomes. Objectives To examine birth outcomes of infants born to mothers with IDD and assess associations with demographics and IDD‐type. Methods We used data from the Big Data for Little Kids project, which links Wisconsin birth records to Medicaid claims for live births covered by Medicaid from 2007 to 2016. We identified IDD using maternal prepregnancy Medicaid claims and ran Poisson regression (with a log link function) with robust variance clustered by mother to compare prevalence of outcomes between singleton births with and without mothers with IDD. We adjusted the associations for demographic factors and estimated prevalence ratios (PR) as the effect measure. We assessed outcomes by IDD‐type (intellectual disability, genetic conditions, cerebral palsy, and autism spectrum disorder) to explore differences by categories of IDD. Results Of 267,395 infants, 1696 (0.6%) had mothers with IDD. A greater percentage of infants with mothers with IDD were born preterm (12.8% vs 7.8%; PR 1.64, 95% confidence interval [CI] 1.42, 1.89), small for gestational age (8.5% vs 5.4%; PR 1.42, 95% CI 1.25, 1.61), and died within 12 months of birth (3.2% vs 0.7%; PR 4.93, 95% CI 3.73, 6.43) compared to infants of mothers without IDD. Prevalence ratios were robust to adjustment for demographics factors. Estimates did not meaningfully differ when comparing different IDD‐types. Conclusions A greater porportion of infants born to mothers with IDD who were covered by Medicaid had poor outcomes compared to other infants. Prevalence of poor infant outcomes was greater for mothers with IDD even after accounting for demographic differences. It is imperative to understand why infants of mothers with IDD are at greater risk so interventions and management can be developed.

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Section: Resultssupporting

confidence: 78%

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

Rubenstein

Ehrenthal

Mallinson

et al. 2021

Paediatric Perinatal Epid

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“…In addition, women with intellectual disability may face increased barriers when navigating the health care service system [ 31 ], especially for pregnancy care [ 9 ]. The increased risk for caesarean delivery for women with cerebral palsy may be due to chronic pain, pelvic abnormalities, spasticity, and other physical disabilities [ 12 ]. Because of the approximate 4:1 male to female sex ratio in autism [ 32 ], and temporal cohort effects [ 3 ], we saw relatively fewer births to women on the autism spectrum.…”

Section: Discussionmentioning

confidence: 99%

“…Further, little is known about pregnancy outcomes among specific IDD types (e.g. cerebral palsy, intellectual disability) and more work is needed, as there may be different associations with outcomes based on phenotypic and genetic presentation of the IDD [ 12 ]. Adults of color with disabilities often face compounded disparity that leads to excess poor health [ 13 , 14 ], but literature is lacking surrounding pregnancy in women of color with IDD [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…They tend to lack the knowledge and experience to treat disabled women who are pregnant and expect these pregnancies to be associated with complications and poor outcomes (Mitra et al, 2016). The few studies focusing on women with CP and pregnancy found that women experience a decline in physical mobility and function after pregnancy, yet there was no evidence of specialist accommodations in place for these women, either before, during or after childbirth (Hayward et al, 2017;Sundelin et al, 2020).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Barriers and enablers to participating in regular screening programmes for women with cerebral palsy: A qualitative life course study

Shah

Taylor

Bradbury‐Jones

2021

Journal of Advanced Nursing

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Aims: To determine the barriers and enablers to regular, women-oriented screening programmes for women with cerebral palsy (CP); and to discuss the participants' suggestions for change.Design: Qualitative life course approach.Methods: Twenty-five life course interviews were conducted with women in 2020 who identified as having a diagnosis of CP. Interviews were conducted in person or using electronic platforms. Framework analysis was used to interpret the data.Findings: Access and utilization of regular screening programmes for women with CP across the life course are determined by multiple socioecological factors. Three themes are discussed focusing particularly on cervical and breast screening: 1. barriers, 2. enablers and 3. women's suggestions for change. Some women chose to opt out of sexual health checks for fear they would be too uncomfortable or the procedure would be too difficult. Practitioner attitudes towards disability in general, as well as the extent to which they understood the effects of CP for women, was highlighted as a barrier. Accessibility and adaptability of the environment also influenced women's uptake of screening. Conclusion:Women with CP face many challenges to their sexual and reproductive healthcare. These can deter them from participating in regular women-oriented screening programmes, which puts them at higher risk of preventable diseases.Understanding the lifelong effects of CP for women, and the interaction with their reproductive health could help to reduce unmet needs and increase participation in relevant screening across the life course.Impact: Knowledge of the challenges to regular screening programmes experienced by women with CP across the life course is crucial to provide appropriate preventative healthcare for women with CP across different stages of life. Elements of this knowledge could have benefits for the care of all disabled women.

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Pregnancy outcome in women with cerebral palsy: A nationwide population‐based cohort study

Cited by 10 publications

References 34 publications

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

Birth outcomes affecting infants of mothers with intellectual and developmental disabilities

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

Barriers and enablers to participating in regular screening programmes for women with cerebral palsy: A qualitative life course study

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