Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America.
PLoS One. 2020 Oct 27;15(10):e0241298. doi: 10.1371/journal.pone.0241298. eCollection 2020.
Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016.
Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race.
Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model.
Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.
智障和发育障碍（ID）女性可能面临更差的妊娠结局风险。我们的目的是评估 2007 年至 2016 年期间威斯康星州医疗补助计划中 ID 女性与非 ID 女性的妊娠并发症和母婴结局风险。
数据来自“大数据关爱儿童”项目，这是一个数据链接，它创建了一个基于威斯康星州母婴的行政数据队列。在分娩前一年有≥1 项 ID 索赔的女性被归类为 ID 女性。常见的妊娠并发症和产妇母婴结局是从分娩记录中确定的。我们使用对数线性回归计算风险比（RR），并通过母亲进行聚类。我们按 ID 类型对结果进行分组，并按种族探索交互作用。
在 177691 例活产女性中，有 1032 例（0.58%）有 ID 索赔。在 274865 例分娩中，有 1757 例是 ID 女性分娩（0.64%）。与其他女性相比，ID 女性患妊娠期糖尿病（RR：1.28，95%CI：1.0，1.6）、妊娠期高血压（RR：1.22，95%CI：1.0，1.5）和剖宫产（RR 1.32，95%CI：1.2，1.4）的风险更高。调整人口统计学协变量后并未改变估计值。智力障碍女性患妊娠期高血压的风险最高。与乘法模型相比，ID 黑人女性患妊娠期高血压的风险更高。
威斯康星州医疗补助计划中 ID 女性妊娠并发症和不良母婴结局风险增加。结果在调整后仍然稳健。ID 类型和黑人种族的独特模式值得进一步探索。
