Adverse Birth Outcomes Among Women with Physical Disabilities: A Retrospective Cohort Study in South Carolina

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all Medicaid insured births in South Carolina between 2007-2015. Women with disabilities were identified using ICD-9-CM codes from hospital discharge records and the neonate outcomes were ascertained from birth certificates. Birth outcomes included preterm birth and as low birth weight, and exploratory outcomes of small for gestational age (SGA) and admission to Neonatal Intensive Care Unit (NICU). In adjusted regression analysis, women with a physical disability were significantly more likely to have a preterm birth (aOR=2.35, 95% CI: 1.75-3.39), very preterm birth (aOR=2.29,95% CI: 1.02-5.16), low birth weight (OR=1.90, 95% CI: 1.37-2.65), very low birth weight (aOR=2.65, 95% CI: 1.25-5.64) and admission to NICU (aOR=2.90, 95% CI: 1.70-3.40) compared to women without a physical disability. The association of SGA and maternal physical disability was not significant after adjusting with the covariates (OR=1.25, 95% CI: 0.89- 1.76). The study showed women with physical disability who delayed prenatal care were significantly more likely to have adverse pregnancy outcome (preterm birth: aOR=2.06, 95% CI: 1.03-4.12; low birth weight: aOR=2.53, 95% CI:1.20-5.35) as compared those who started early care. We conclude that though there are some risks of adverse outcomes for physical disabled women these risks can be minimized by utilizing early prenatal care. These analyses provide insight into some challenges that need to be managed in order to improve outcomes for women with physical disability