Greater risk of adverse pregnancy outcomes in women with intellectual disability

1. Women with intellectual or developmental disorders were more likely to experience preeclampsia, preterm birth, and venous thromboembolism (VTE).

2. Women with these disabilities were more likely to have small for gestational age (SGA) babies.

Evidence Rating Level: 2 (Good)           

Study Rundown: Intellectual disabilities (ID), such as autism, chromosomal disorders, and fetal alcohol syndrome (FAS), are characterized by limited cognitive, social and practical skills. Individuals with these conditions often have lower socioeconomic status, limited access to health care, less involvement in medical decision making, and experience numerous health disparities. While historically women with ID were often forced to undergo sterilization, in more modern times increasingly more women with ID are undergoing pregnancy and having children. Previous studies suggested that women with ID are more likely to experience preeclampsia, preterm birth and perinatal mortality, but there has been relatively little research in this area and results have been mixed. In the present work, authors found that women with ID were more likely to have preeclampsia, preterm birth, and VTE and that their infants were more likely to be SGA.

Strengths of the study included a large, comprehensive population-based dataset and assessment of a broad spectrum of pregnancy outcomes. The study was limited by use of billing codes to identify women with intellectual or developmental disorders, which may have resulted in misclassification of study participants. Additionally, findings may not be readily generalized to vulnerable populations with limited access to healthcare. Further prospective studies are needed to verify these findings to better inform obstetric care among women with ID.

Click to read the study in BJOG

Relevant Reading: Women with intellectual disability at risk of adverse pregnancy and birth outcomes

In-Depth [retrospective cohort]: This study evaluated the relationship between ID and pregnancy outcomes among 3932 women with and 382 774 without these disorders. Patients were classified as having an intellectual or developmental disorder if they had a diagnostic code for conditions such as autism, pervasive developmental disorder, chromosomal abnormalities, FAS and intellectual disability. Primary outcomes of interest included gestational diabetes and hypertension, pre-eclampsia, eclampsia, venous thromboembolism, preterm birth, and small or large for gestational age infants. Secondary outcomes were maternal hemorrhage, severe obstetric morbidity, systemic maternal complications, stillbirth, and neonatal morbidity and mortality.

Women with ID were more likely to experience preeclampsia (RR 1.47, 95% CI 1.11-1.93) and VTE (RR 1.60, 95% CI 1.17-2.19). Preterm birth (RR 1.63, 95% CI 1.47-1.80) and SGA infants (RR 1.35, 95% CI 1.25-1.45) were also more likely in this group. All secondary outcomes were more likely among women with ID (p ≤ 0.001 for all).

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