Brown Hilary K, Cobigo Virginie, Lunsky Yona, Vigod Simone
1 Women's College Research Institute , Women's College Hospital, Toronto, Canada .
2 Department of Psychiatry, University of Toronto , Toronto, Canada .
J Womens Health (Larchmt). 2017 Apr;26(4):329-337. doi: 10.1089/jwh.2016.5979. Epub 2017 Jan 24.
Women with intellectual and developmental disabilities have high rates of pregnancy complications. However, their postpartum health is largely unknown. We compared risks for postpartum hospital admissions and emergency department visits among women with and without intellectual and developmental disabilities.
We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton live births to women with (N = 3,803) and without intellectual and developmental disabilities (N = 378,313) (2002-2012). Outcomes were hospital admissions and emergency department visits in the 42 days following delivery discharge. We classified these as medical or psychiatric depending on the recorded primary discharge diagnosis.
Women with intellectual and developmental disabilities, compared to those without, had increased risk for postpartum hospital admissions overall (2.4% vs. 1.2%; adjusted hazard ratios [aHR]: 1.76, 95% confidence interval [CI]: 1.43-2.17) and for psychiatric reasons (0.8% vs. 0.1%; aHR: 10.46, 95% CI: 6.96-15.70), but not for medical reasons. They also had increased risk for postpartum emergency department visits overall (16.6% vs. 7.9%; aHR: 1.85, 95% CI: 1.71-2.01) and for both medical (15.8% vs. 7.8%; aHR: 1.80, 95% CI: 1.66-1.96) and psychiatric reasons (1.3% vs. 0.1%; aHR: 5.66, 95% CI: 4.17-7.69).
High rates of postpartum hospital admissions and emergency department visits among women with intellectual and developmental disabilities demonstrate that this group may be vulnerable to acute complications or inadequate preventive care after childbirth. Providing enhanced health services during the postpartum period, in the form of longer or more frequent visits or specialized supports, could optimize their outcomes following delivery.
患有智力和发育障碍的女性怀孕并发症发生率很高。然而，她们产后的健康状况在很大程度上尚不明确。我们比较了有和没有智力和发育障碍的女性产后住院和急诊就诊的风险。
我们利用加拿大安大略省卫生和社会服务管理部门的关联数据进行了一项基于人群的研究，以确定有智力和发育障碍的女性（N = 3803）和无智力和发育障碍的女性（N = 378313）（2002 - 2012年）的单胎活产情况。结局指标是分娩出院后42天内的住院和急诊就诊情况。根据记录的主要出院诊断，我们将这些情况分为医疗或精神科。
与没有智力和发育障碍的女性相比，有智力和发育障碍的女性产后总体住院风险增加（2.4%对1.2%；调整后风险比[aHR]：1.76，95%置信区间[CI]：1.43 - 2.17），因精神科原因住院风险增加（0.8%对0.1%；aHR：10.46，95% CI：6.96 - 15.70），但因医疗原因住院风险未增加。她们产后急诊就诊的总体风险也增加（16.6%对7.9%；aHR：1.85，95% CI：1.71 - 2.01），因医疗原因（15.8%对7.8%；aHR：1.80，95% CI：: 1.66 - 1.96）和精神科原因（1.3%对0.1%；aHR：5.66，95% CI：4.17 - 7.69）就诊的风险均增加。
患有智力和发育障碍的女性产后住院和急诊就诊率较高，表明该群体在分娩后可能易患急性并发症或预防保健不足。在产后期间提供强化的卫生服务，如延长就诊时间或增加就诊频率或提供专门支持，可能会优化她们分娩后的结局。
