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Rates of recognized pregnancy in women with disabilities in Ontario, Canada

Published:November 02, 2019DOI:https://doi.org/10.1016/j.ajog.2019.10.096

      Objective

      One in 10 reproductive-aged women has a physical, sensory, or intellectual/developmental disability.
      • Statistics Canada
      Disability in Canada: initial findings from the Canadian Survey on Disability.
      The prevailing assumptions are that these women are not sexually active or are unlikely to experience pregnancy because of their medical risk.
      • Silver M.G.
      Eugenics and compulsory sterilization laws: providing redress for the victims of a shameful era in United States history.
      We compared the rates of a recognized pregnancy among women with and without disabilities.

      Study Design

      This population-based, repeated, cross-sectional study was completed in Ontario, Canada. Health administrative data sets, covering the whole population, were linked using a unique encoded identifier and accessed and analyzed at ICES. Included were women aged 15–44 years who had an identified physical, sensory, or intellectual/developmental disability, based on ≥2 physician visits or ≥1 emergency department visits or hospitalizations between database inception and study entry.
      • Darney B.G.
      • Biel F.M.
      • Quigley B.P.
      • Caughey A.B.
      • Horner-Johnson W.
      Primary caesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
      ,
      • Lin E.
      • Balogh R.
      • Cobigo V.
      • Ouellette-Kuntz H.
      • Wilton A.
      • Lunsky Y.
      Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms.
      Rates of recognized pregnancy (any live birth, pregnancy loss, or induced abortion) were calculated per 1000 women in fiscal year 2017/2018 for each disability group overall and by 5 year age groups and then compared by Poisson regression to women without any documented disability. Changes in rates between 2003/2004 and 2017/2018 were also assessed by Poisson regression, with a year*disability status interaction term. Time trends were plotted using 3 year moving averages. Data use was authorized under section 45 of Ontario’s Personal Health Information Protection Act.

      Results

      In 2017/2018, there were 253,661 15-44 year old women with a physical, 91,695 with a sensory, 8919 with an intellectual/developmental, and 29,515 with ≥2 (multiple) disabilities and 2,335,019 women without disabilities. Compared with women without disabilities, overall recognized pregnancy rates were slightly lower in those with physical or sensory disabilities and much lower in women with intellectual/developmental or multiple disabilities (Figure 1). Adolescent pregnancy rates were highest in women with intellectual/developmental disabilities and also higher in women with physical and sensory disabilities, each compared with women without disabilities (Figure 1).
      Figure thumbnail gr1
      Figure 1Rates and ratios of recognized pregnancy among 15–44 year old women
      Rates and unadjusted rate ratios of a recognized pregnancy among 15–44 year old women in Ontario, Canada, 2017/2018, who had a physical, sensory, or intellectual/developmental disability (IDD) or ≥2 (multiple) disabilities, compared with women without any such disability (none). Data are presented overall and by 5 year age group.
      Brown. Rates of recognized pregnancy in women with disabilities in Ontario. Am J Obstet Gynecol 2020.
      Between 2003/2004 and 2017/2018, pregnancy rates decreased slightly in women without disabilities and appeared stable among those with physical or intellectual/developmental disabilities. However, pregnancy rates rose significantly in women with sensory or multiple disabilities (year*disability status interaction term P < .0001) (Figure 2). Of all pregnancies, the proportion in women with any disability increased from 8.5% in 2003/2004 to 13.0% in 2017/2018.
      Figure thumbnail gr2
      Figure 2Trends in rates of recognized pregnancy among 15–44 year old women
      Temporal trends in the rates of a recognized pregnancy among 15–44 year old women in Ontario, Canada, in 2003/2004–2005/2006 to 2015/2016–2017/2018 who had a physical, sensory, or intellectual/developmental disability (IDD) or ≥2 (multiple) disabilities, contrasted with women without any such disability (none). Data are presented as 3 year moving averages.
      Brown. Rates of recognized pregnancy in women with disabilities in Ontario. Am J Obstet Gynecol 2020.
      In additional analyses, there were lower rates of pregnancies ending in live birth or induced abortion per 1000 women in each disability group vs women without disabilities. However, rates of pregnancy loss were slightly, although nonsignificantly, elevated in women with physical (risk ratio, 1.04, 95% confidence interval, 1.00–1.09) or sensory disabilities (risk ratio, 1.06, 95% confidence interval, 0.99–1.13) compared with nondisabled women.

      Conclusion

      Our findings counter assumptions that pregnancy rarely occurs in women with disabilities.
      • Silver M.G.
      Eugenics and compulsory sterilization laws: providing redress for the victims of a shameful era in United States history.
      Higher pregnancy rates in adolescents with (vs without) disabilities are concerning and may speak to the need for better access to sexual health education and contraception. Women with disabilities have reported barriers accessing reproductive health care services, including providers who are reluctant to discuss their reproductive health, physically inaccessible care settings, and lack of tailored information.
      • Malouf R.
      • Henderson J.
      • Redshaw M.
      Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey.
      Given that 1 in 8 pregnancies herein was among women with a disability, greater attention to the reproductive and perinatal health care needs of women with disabilities is warranted.

      References

        • Statistics Canada
        Disability in Canada: initial findings from the Canadian Survey on Disability.
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        Eugenics and compulsory sterilization laws: providing redress for the victims of a shameful era in United States history.
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        • Quigley B.P.
        • Caughey A.B.
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        Primary caesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
        Womens Health Issues. 2017; 27: 336344
        • Lin E.
        • Balogh R.
        • Cobigo V.
        • Ouellette-Kuntz H.
        • Wilton A.
        • Lunsky Y.
        Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms.
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        • Redshaw M.
        Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey.
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