Identifying Pregnant Women With Disabilities and Maternal and Newborn Outcomes

Pregnant women with disabilities are at higher risk of poor pregnancy and birth outcomes. Different methods for identifying disability may affect estimates of health disparities in this population.

To compare pregnancy and birth outcomes among pregnant women using different ways of identifying maternal disability.

Retrospective cohort study of linked vital records and maternal and newborn claims for Medicaid-insured live births from January 2010 to December 2014 in Texas. Data analysis was conducted from October 2023 to May 2024.

Births grouped into 5 maternal cohorts: no identified disability, disability benefits enrollment only, disability diagnostic code only, both benefits enrollment and a diagnostic code, and either disability benefits or a diagnostic code.

Mode of delivery (cesarean) and severe maternal morbidity (SMM) were identified from maternal claims. Low birthweight (LBW), preterm birth (PTB), and small for gestational age (SGA) were identified from birth certificates. Modified Poisson regression with robust variance estimators was used to estimate adjusted risk ratios (aRRs) for the association of each of the 5 outcomes with disability group status.

Among 921 218 births (mean [SD] maternal age at birth, 25.1 [5.7] years), 895 201 (97.2%) were to mothers with no disability, 6160 (0.7%) were to mothers enrolled in disability benefits only, 17 742 (1.9%) were to mothers with a disability diagnostic code only, 2115 (0.2%) were to mothers with both benefits enrollment and a disability code, and 26 017 (2.8%) were to mothers meeting either disability definition. Compared with those without disabilities, those with only disability diagnostic codes had the highest rates for cesarean delivery (306 589 births [34.3%] vs 7658 births [43.2%]), LBW (750 058 births [8.4%] vs 869 births [14.2%]), and PTB (92 807 births [10.4%] vs 977 births [15.9%]). Compared with those with no disability, the adjusted relative risks were highest in the diagnostic codes only group for cesarean delivery (aRR, 1.22; 95% CI, 1.20-1.24), LBW (aRR, 1.77, 95% CI, 1.71-1.84), and PTB (aRR, 1.68; 95% CI, 1.62-1.74). The risk for SMM (aRR, 4.82; 95% CI, 3.96-5.86) and SGA (aRR, 1.43; 95% CI, 1.24-1.66) were highest in those with both benefits enrollment and a disability code.

In this cohort study, disability was associated with adverse outcomes, regardless of definition. However, the burden of disparities was dependent on how disability was defined, suggesting that the assessment of disability-associated health risks should consider how disability is conceptualized.