Maternal outcomes among women with intellectual disabilities in comparison with the general population (IDcare)

Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.

Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.

This was a register study based on all women living in Skåne, Sweden on January 1^st, 2104, with at least 1 singleton birth in 2014-2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.

In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15-2.42), infections of the genitourinary tract (2.30, 1.67-3.16), premature rupture of membranes (2.42, 1.24-4.69 for women with mild intellectual disability), and false labor (1.27, 1.05-1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.

Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.