552 Risk of adverse maternal and obstetric outcomes among pregnant women with disabilities

Abstract

Pregnancy rates among women with disabilities are increasing. Emerging evidence suggests women with disabilities are at higher risk of complications, particularly preterm birth, gestational diabetes, preeclampsia and delivery via cesarean, though association with other outcomes is understudied. We performed a comprehensive study of obstetric interventions and adverse maternal outcomes among women with disabilities. In singleton pregnancies from the Consortium on Safe Labor study, we used ICD-9 codes to define disability. We estimated adjusted relative risk (aRR) of 21 maternal and obstetric outcomes (including composite variables for pregnancy and labor and delivery complications; Figure) and cesarean indications, among women with any disability (n=2,142) and each category (physical, sensory, or intellectual) compared to no disability (n=221,252). Compared to women with no disability, women with disabilities were at higher risk of both composite pregnancy and labor/delivery complications (Figure). Specifically, women with disabilities were at significantly higher risk (aRR ranged from 1.07-1.55) for hypertensive disorders, gestational diabetes, placenta previa, PROM, PPROM, hemorrhage, and postpartum fever, as well as maternal thromboembolism (aRR 5.77; CI 3.83-8.69) and maternal death (aRR=9.99; CI 2.17, 45.6). Heightened risk varied but was generally consistent across all disability categories. Women with any disability also had higher risk of interventions including oxytocin augmentation, operative vaginal delivery and cesarean delivery (aRR 1.33; 95%CI: 1.25, 1.42). Cesarean risk was increased for both prelabor (planned) and intrapartum cesarean, and was consistent across disability categories (Table). Women with disabilities were at higher risk of obstetric interventions, a broad range of severe maternal morbidity, and maternal mortality, a concerning and unanticipated finding. Future research should explore disparity reasons to design interventions targeted at improving outcomes in women with disabilities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)