Maternal Fetal Medicine
Oral or Poster Presentation
Concurrent Session 4A - Perinatal Epidemiology
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.