Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
Paediatr Perinat Epidemiol. 2021 Nov;35(6):706-716. doi: 10.1111/ppe.12765. Epub 2021 May 6.
Women with intellectual and developmental disabilities (IDD) face increased risk of adverse maternal pregnancy outcomes, yet less is known about infant outcomes.
To examine birth outcomes of infants born to mothers with IDD and assess associations with demographics and IDD-type.
We used data from the Big Data for Little Kids project, which links Wisconsin birth records to Medicaid claims for live births covered by Medicaid from 2007 to 2016. We identified IDD using maternal prepregnancy Medicaid claims and ran Poisson regression (with a log link function) with robust variance clustered by mother to compare prevalence of outcomes between singleton births with and without mothers with IDD. We adjusted the associations for demographic factors and estimated prevalence ratios (PR) as the effect measure. We assessed outcomes by IDD-type (intellectual disability, genetic conditions, cerebral palsy, and autism spectrum disorder) to explore differences by categories of IDD.
Of 267,395 infants, 1696 (0.6%) had mothers with IDD. A greater percentage of infants with mothers with IDD were born preterm (12.8% vs 7.8%; PR 1.64, 95% confidence interval [CI] 1.42, 1.89), small for gestational age (8.5% vs 5.4%; PR 1.42, 95% CI 1.25, 1.61), and died within 12 months of birth (3.2% vs 0.7%; PR 4.93, 95% CI 3.73, 6.43) compared to infants of mothers without IDD. Prevalence ratios were robust to adjustment for demographics factors. Estimates did not meaningfully differ when comparing different IDD-types.
A greater porportion of infants born to mothers with IDD who were covered by Medicaid had poor outcomes compared to other infants. Prevalence of poor infant outcomes was greater for mothers with IDD even after accounting for demographic differences. It is imperative to understand why infants of mothers with IDD are at greater risk so interventions and management can be developed.
患有智力和发育障碍 (IDD) 的女性面临着增加的不良妊娠结局风险，但对于婴儿结局的了解较少。
研究 IDD 母亲所生婴儿的出生结局，并评估其与人口统计学特征和 IDD 类型的关系。
我们使用了来自“大数据用于儿童”项目的数据，该项目将威斯康星州的出生记录与 2007 年至 2016 年期间由医疗补助计划覆盖的活产儿的医疗补助索赔相链接。我们通过母亲产前医疗补助索赔来识别 IDD，并使用泊松回归（对数链接函数）对母亲进行稳健方差聚类，以比较有无 IDD 母亲的单胎出生结局的发生率。我们调整了人口统计学因素的关联，并将患病率比 (PR) 作为效应量进行估计。我们按 IDD 类型（智力障碍、遗传疾病、脑瘫和自闭症谱系障碍）评估了结果，以探讨不同 IDD 类别的差异。
在 267395 名婴儿中，有 1696 名（0.6%）母亲患有 IDD。患有 IDD 母亲的婴儿中，早产儿的比例更高（12.8%比 7.8%；PR 1.64，95%置信区间 [CI] 1.42，1.89），小于胎龄儿的比例更高（8.5%比 5.4%；PR 1.42，95% CI 1.25，1.61），并且在出生后 12 个月内死亡的比例更高（3.2%比 0.7%；PR 4.93，95% CI 3.73，6.43）。与没有 IDD 的母亲所生婴儿相比，这些结果在调整人口统计学因素后仍然稳健。当比较不同的 IDD 类型时，估计值没有明显差异。
与其他婴儿相比，更多由医疗补助计划覆盖的 IDD 母亲所生婴儿的结局较差。即使考虑到人口统计学差异，患有 IDD 的母亲所生婴儿的不良结局发生率也更高。了解为什么 IDD 母亲的婴儿风险更高是至关重要的，以便可以制定干预和管理措施。
