Impact of social, health, and disability-related factors on pregnancy outcomes in women with intellectual and developmental disabilities: a population-based latent class analysis

Background — Studies have shown women with intellectual and developmental disabilities (IDD) have elevated risks of perinatal complications, but few studies have examined how social, health, and disability-related factors affect these risks.

Objectives — To identify and describe subgroups of pregnant women with IDD according to social, health, and disability-related factors and examine the risks of perinatal complications in these subgroups compared to women without IDD.

Methods — We performed a population-based cohort study in Ontario, Canada, of women with (n=1,922) and without (n=1,126,854) IDD, with a singleton birth in 2013-2018. We used latent class analysis (LCA) to identify subgroups of women according to social (e.g., age), health (e.g., chronic medical conditions), and disability-related (e.g., IDD type) characteristics. Modified Poisson regression was then used to compare the risks of hypertensive disorders of pregnancy, caesarean delivery, and preterm birth across identified subgroups to women without IDD.

Results — The LCA identified 4 classes of women with IDD: (1) young women who were mostly healthy and had little primary care before pregnancy (n=253); (2) older women who were mostly healthy (n=795); (3) young to mid-aged women who had significant comorbidities (n=181); and (4) young women, many of whom were autistic, who had some medical comorbidities and significant psychiatric comorbidities (n=693). Class 3 consistently had the greatest risks of perinatal complications, across all IDD groups, compared to women without IDD.

Conclusions — These findings underscore the importance of multidisciplinary care approaches tailored to the needs of at-risk women with IDD, in the preconception and perinatal periods.