Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study

• Published in: Maternal and child health journal Vol. 22; no. 10; pp. 1492 - 1501
• Main Authors: Mitra, Monika, Parish, Susan L., Akobirshoev, Ilhom, Rosenthal, Eliana, Moore Simas, Tiffany A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2018; Springer; Springer Nature B.V
• Subjects: Adult; Cohort analysis; Delivery, Obstetric; Demographic aspects; Developmental disabilities; Developmental Disabilities - epidemiology; Disabilities; Emergency medical services; Emergency Service, Hospital - statistics & numerical data; Female; Gynecology; Health aspects; Health problems; Hospitalization - statistics & numerical data; Humans; Intellectual disabilities; Intellectual Disability - epidemiology; Massachusetts - epidemiology; Maternal and Child Health; Medical care utilization; Medicine; Medicine & Public Health; Patient admissions; Pediatrics; Physiological aspects; Population Economics; Postpartum Period; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome - epidemiology; Public Health; Puerperium; Retrospective Studies; Social aspects; Sociology; Survival analysis; Womens health; United States; Disability; Pregnancy; Obstetrics/gynecology; Cohort analysis; Intellectual and developmental disabilities; Postpartum
• ISSN: 1092-7875; 1573-6628; 1573-6628
• DOI: 10.1007/s10995-018-2546-6

Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002–2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n = 1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1–42, 43–90, and 1–365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1–42, 43–90, and 91–365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.