Newborns of women with disabilities have higher rates of health complications after birth
There is a mild to moderate elevated risk for complications such as preterm birth among newborns of women with disabilities compared to those without disabilities, according to a new study by researchers at ICES and the University of Toronto.
Advances in obstetric and newborn care have improved newborn outcomes in industrialized countries. However, there remain important disparities in outcomes such as preterm birth, neonatal morbidity, and neonatal mortality, especially for groups facing social and structural barriers to health, such as poverty and systemic racism.
A group that has received less attention is women with disabilities, who have challenges accessing health care. A new study published in Pediatrics included groups of newborns of women with a physical (144,187), sensory (44,988), intellectual/developmental (2,207), or two or more disabilities (8,823), compared to 1,593,354 newborns of women without a disability.
“Most infants born to disabled women were healthy. There was, however, elevated risk for a number of health complications in newborns of mothers with a disability compared to those without a disability,” says Hilary Brown, adjunct scientist at ICES and assistant professor in the Department of Health and Society at the University of Toronto. “While these complications are rare, the disparities in neonatal outcomes between women with and without disabilities suggests that more could be done to support women with disabilities during pregnancy, and their newborns in the weeks after birth.”
From 2003 to 2018 in Ontario, Canada, the data show that overall, newborns of women with disabilities, compared to those of women without disabilities, had:
- Higher rates of preterm birth at less than 37 weeks (7.3%-9.9% across disability groups, vs. 6.2% in newborns of women without disabilities),
- Preterm birth at less than 34 weeks (1.8%-2.6%, vs. 1.5%), and
- Small for gestational age (11.7%-17.0%, vs. 12.3%).
Notably, newborns of women with disabilities also had higher rates of neonatal morbidity, neonatal abstinence syndrome, and neonatal intensive care unit (NICU) admission. Across the disability groups, newborns of women with intellectual/developmental and multiple disabilities had the highest risks for complications.
The researchers used diagnoses to identify disability, which may not capture environmental influences on women’s lived experience of disability and may miss individuals who are misdiagnosed or undiagnosed. Further, there was no individual data on socioeconomic status or race and ethnicity. Future research could explore the dual impact of ableism and racism on health outcomes in newborns.
“Our findings signal a need to attend to the broader social determinants of health that impact these outcomes,” says Yona Lunsky, adjunct scientist at ICES and senior scientist at the Centre for Addiction and Mental Health. “Women with disabilities need improved access to high-quality proactive health care before, during and after pregnancy that is adapted to their needs, including chronic disease management, health promotion, and social support.”
Brown says that practitioners and health care leaders need to adapt the health care environment to support women with disabilities. “The creation of newborn care spaces such as neonatal intensive care units and pediatricians’ offices should consider the physical, communication, and other disability accommodation needs of mothers; most NICUs do not accommodate a wheelchair, for example. Obstetricians and pediatricians should also receive training to improve disability competency to understand the unique needs of women with disabilities.”
The study, “Neonatal outcomes of mothers with a disability,” was published in Pediatrics.
Author block: Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y.
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