Interdisciplinary Centre for Health and Society, University of Toronto Scarborough (Brown), Dalla Lana School of Public Health (Brown, Liu), Department of Medicine (Ray) and Department of Psychiatry (Lunsky, Vigod), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Institute for Clinical Evaluative Sciences (Brown, Ray, Liu, Lunsky, Vigod); Li Ka Shing Knowledge Institute (Ray), St. Michael's Hospital; Centre for Addiction and Mental Health (Lunsky), Toronto, Ont.
CMAJ. 2018 Aug 13;190(32):E949-E956. doi: 10.1503/cmaj.170932.
Rapid repeat pregnancy within 12 months of a live birth is associated with adverse perinatal outcomes. We evaluated the risk for rapid repeat pregnancy among women with intellectual and developmental disabilities, with whom sharing of information about pregnancy planning and contraception may be inadequate.
We accessed population-based health administrative data for all women with an index live birth in Ontario, Canada, for the period 2002-2013. We used modified Poisson regression to compare relative risks (RRs) for a rapid repeat pregnancy within 12 months of the index live birth in women with and without intellectual and developmental disabilities, first adjusting for demographic factors and then additionally adjusting for social, health and health care disparities.
We compared 2855 women with intellectual and developmental disabilities and 923 367 women without such disabilities. At the index live birth, women with intellectual and developmental disabilities were more likely to be younger than 25 years of age (46.8% v. 18.2%) and to be disadvantaged on each measure of social, health and health care disparities. These women had a higher rate of rapid repeat pregnancy than those without such disabilities (7.6% v. 3.9%; adjusted RR 1.34, 95% confidence interval [CI] 1.18-1.54, after controlling for demographic factors). This risk was attenuated upon further adjustment for social, health and health care disparities (adjusted RR 1.00, 95% CI 0.87-1.14).
Rapid repeat pregnancy, which was more common among women with intellectual and developmental disabilities, may be explained by social, health and health care disparities. To optimize reproductive health, multifactorial approaches to address the marginalization experienced by this population are likely needed.
在活产后 12 个月内再次怀孕与不良围产期结局相关。我们评估了智力和发育障碍女性快速重复妊娠的风险，因为这些女性在妊娠计划和避孕方面的信息共享可能不足。
我们获取了加拿大安大略省所有活产女性的人群健康行政数据，时间范围为 2002 年至 2013 年。我们使用修正泊松回归比较了有和无智力和发育障碍的女性在活产后 12 个月内快速重复妊娠的相对风险（RR），首先调整了人口统计学因素，然后进一步调整了社会、健康和医疗保健差异。
我们比较了 2855 名有智力和发育障碍的女性和 923367 名无此类障碍的女性。在活产时，有智力和发育障碍的女性比无此类障碍的女性更年轻（46.8%比 18.2%），并且在每个社会、健康和医疗保健差异指标上都处于劣势。这些女性的快速重复妊娠率高于无此类障碍的女性（7.6%比 3.9%；调整后的 RR 1.34，95%置信区间 [CI] 1.18-1.54，在控制了人口统计学因素后）。进一步调整社会、健康和医疗保健差异后，这种风险减弱（调整后的 RR 1.00，95% CI 0.87-1.14）。
快速重复妊娠在智力和发育障碍女性中更为常见，可能与社会、健康和医疗保健差异有关。为了优化生殖健康，可能需要采取多因素方法来解决这一人群面临的边缘化问题。
