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

Abstract

Background Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. Objectives To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. Data sources We searched Medline and CINAHL for articles published January 2009–April 2020 following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection and data extraction Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non‐physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low‐ or middle‐income countries. Data extraction was done using predefined data fields. Synthesis All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). Results A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross‐sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post‐delivery hospitalisations, while their infants may be at risk of low birthweight and small‐for‐gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. Conclusions Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.

Barriers and facilitators to perinatal care of women with disabilities in lower- and middle-income countries: a study protocol for scoping review of qualitative studies

“…Some previous scoping and systematic reviews have broadly documented the evidence on access to maternal services for women with a specific type of disability 40 41 and adverse maternal health outcomes. 42 This study will highlight the inequities and gaps in utilisation of perinatal care among WWD with various types of functional disabilities. There is a dearth of evidence on experience of different types of functional disabilities and perinatal care in LMICs.…”

Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada

“…ED use in pregnancy reflects a range of concerns, including obstetric and medical complications and inadequate outpatient care access. 2,3 Disabled people have elevated rates of pregnancy complications 23,24,34,35 and comorbidities that may be exacerbated in pregnancy. 10,11 In our cohort, rates of ED visits for obstetrical, other medical, and psychiatric reasons were higher in people with disabilities than those without.…”

Perinatal healthcare for women at risk of children’s social care involvement: a qualitative survey of professionals in England

“…Mothers with complex health needs are more likely to have complications during pregnancy and childbirth 2–4. Newborns are directly affected by parental health and health behaviours, via in utero effects to the developing baby and postnatal caregiving practices 5.…”

“…1 Mothers with complex health needs are more likely to have complications during pregnancy and childbirth. [2][3][4] Newborns are directly affected by parental health and health behaviours, via in utero effects to the developing baby and postnatal caregiving practices. 5 There are also indirect harms of poor parental health on infants, including unstable housing, compromised parental capacity and increased risk of child abuse/neglect.…”