Risk of severe maternal morbidity and maternal mortality among women with disabilities in Ontario: A population-based cohort study

Friday, February 14, 2020

5:15 PM – 5:30 PM

Location: Max Bell - MB252

Introduction: Severe maternal morbidity (SMM) and maternal mortality are important indicators of pregnancy-related health. Pregnancy rates among women with disabilities are increasing, and they experience significant social and health disparities that could place them at risk of adverse pregnancy outcomes. We compared the risk of SMM or maternal mortality among women with physical, sensory, and intellectual/developmental disabilities to women without disabilities.

Methods: We conducted a population-based cohort study using linked health administrative data on all singleton livebirths and stillbirths in Ontario, Canada, in 2003-2017. We included 134,536 women with physical, 41,209 with sensory, 2,021 with intellectual/developmental, and 8,001 with multiple disabilities, and 1,499,703 women without disabilities. SMM (a composite of 40 diagnostic and procedural indicators) and maternal mortality were measured between conception and 42 days postpartum. We also measured late SMM and maternal mortality, between 43-365 days postpartum. We used modified Poisson regression to compare the risks of SMM or maternal mortality in each disability group vs. women without disabilities.

Results: After adjustment for maternal age, parity, income quintile, rurality, and medical and psychiatric comorbidities, women with physical (aRR 1.28, 95% CI 1.23-1.33), sensory (aRR 1.13, 95% CI 1.05-1.21), intellectual/developmental (aRR 1.55, 95% CI 1.20-2.01), and multiple disabilities (aRR 1.70, 95% CI 1.51-1.92) were at increased risk for SMM or maternal mortality between conception and 42 days postpartum, compared to women without disabilities. Risk was greatest in pregnancy (aRRs 1.26 to 2.14), followed by the late postpartum period (aRRs 1.22 to 2.05).

Conclusion: These findings demonstrate an urgent need to improve supports for women with disabilities, to prevent these adverse pregnancy outcomes. Women with disabilities may benefit from enhanced preconception care to improve management of comorbidities and other risk factors, along with tailored care during pregnancy and the postpartum period.

Presenter(s)

Hilary Brown, PhD

Assistant Professor
University of Toronto Scarborough

Disclosure: Disclosure information not submitted.

First Author(s)

Hilary Brown, PhD

Assistant Professor
University of Toronto Scarborough

Disclosure: Disclosure information not submitted.

Corresponding Author(s)

Hilary Brown, PhD

Assistant Professor
University of Toronto Scarborough

Disclosure: Disclosure information not submitted.

Author(s)

Simon Chen, MSc

Analyst
ICES

Disclosure: Disclosure information not submitted.
Joel Ray, MD, MSc, FRCPC

Clinician Scientist and Professor
St. Michael's Hospital

Disclosure: Disclosure information not submitted.
Astrid Guttmann, MD

Senior Core Scientist; Chief Science Officer
Institute for Clinical Evaluative Sciences

Disclosure: Disclosure information not submitted.
Susan Havercamp, PhD

Professor
Ohio State University

Disclosure: Disclosure information not submitted.
Susan Parish, PhD

Professor
Virginia Commonwealth University

Disclosure: Disclosure information not submitted.
Simone Vigod, MD, MSc, FRCPC

Clinician Scientist and Associate Professor
Women's College Hospital

Disclosure: Disclosure information not submitted.
Yona Lunsky, PhD

Professor
Centre for Addiction & Mental Health

Disclosure: Disclosure information not submitted.

Submitter(s)

Hilary Brown, PhD

Assistant Professor
University of Toronto Scarborough

Disclosure: Disclosure information not submitted.