A population-based analysis of postpartum acute care use among women with disabilities

Background — Disability is common in reproductive-aged women, and as many as one in eight pregnancies occur in women with a disability. Women with disabilities experience significant social and health disparities, and are at greater risk than their non-disabled counterparts for perinatal complications. Yet, few studies have examined their postpartum acute care use.

Objective — To examine risks of postpartum emergency department visits and hospital admissions among women with and without physical, sensory, and intellectual/developmental disabilities.

Study Design — In this population-based study in Ontario, Canada, women with a singleton obstetrical delivery from 2003-2019 were classified into those with physical (n=155,500), sensory (n=49,338), intellectual/developmental (n=2,650), and ≥2 of these disabilities (“multiple disabilities”, n=9,904), and women without disabilities (n=1,701,574). Primary outcomes were emergency department visits and hospital admissions 0-365 days after index delivery hospital discharge. Secondary outcomes were emergency department visits and hospital admissions by primary diagnosis (medical, psychiatric) and by timing (0-7, 8-42, 43-365 days postpartum). Relative risks (aRR) comparing each disability group to those without disabilities were adjusted for age; parity; income quintile; rurality; immigrant/refugee status; pre-pregnancy chronic medical conditions, mental illness, and substance use disorders; and prenatal care provider type.

Results — Any postpartum emergency department visit occurred in 23.5% of women without a disability, with risks elevated in women with physical (32.9%, aRR 1.27, 95% CI 1.26-1.28), sensory (30.0%, aRR 1.16, 95% CI 1.15-1.18), intellectual/developmental (48.8%, aRR 1.38, 95% CI 1.33-1.44), and multiple disabilities (42.0%, aRR 1.44, 95% CI 1.41-1.48) compared to women without disabilities. Similarly, any postpartum hospital admission occurred in 3.0% of women without a disability, with elevated risks in women with physical (4.8%, aRR 1.37, 95% CI 1.34-1.40), sensory (4.0%, aRR 1.19, 95% CI 1.14-1.24), intellectual/developmental (9.6%, aRR 1.96, 95% CI 1.73-2.21), and multiple disabilities (7.3% aRR 1.77, 95% CI 1.64-1.90). Results were consistent by primary diagnosis and timing in the postpartum period.

Conclusion — Women with disabilities have elevated risk of emergency department visits and hospital admissions in the postpartum period, indicating greater postpartum morbidity, which requires attention through enhanced and extended follow-up across the postpartum period.