Antenatal Hospitalization Among U.S. Women With Intellectual and Developmental Disabilities: A Retrospective Cohort Study.
Monika Mitra, Susan L Parish, Karen M Clements and 2 others
PMID 30198766WHAT IT FOUND
Pregnant women with intellectual and developmental disabilities used emergency departments and inpatient hospital services far more often than matched women without IDD.
They also stayed in the hospital longer, and mental health issues drove a much higher share of their emergency visits.
Key findings
01Women with IDD had significantly higher rates of antenatal emergency department visits (56% vs 29%), observational stays (31% vs 17%), and non-delivery hospital stays (18% vs 4%) compared to women without IDD.
02After controlling for demographics and clinical risk factors, women with IDD remained 2.2 times more likely to have an antenatal emergency visit and 2.3 times more likely to have a non-delivery observational or hospital stay.
03Mental illness was a leading cause of antenatal emergency visits for women with IDD, accounting for 11.0% of their visits compared to less than 1% for women without IDD.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study relied on administrative data from birth certificates and hospital records, meaning diagnoses of IDD could be miscoded or missed, potentially underestimating the true number of affected women. The sample was restricted to Massachusetts residents, where educational and support programs for people with IDD may differ significantly from other states. The study did not include pre-pregnancy hospital utilization, so it is unclear if the high rates of emergency visits were specific to pregnancy or part of a broader pattern of healthcare use. Prenatal care adequacy was measured by the number and timing of visits, not by the quality, accessibility, or communication effectiveness of the care provided.
The easy way to misread this
Do not interpret the higher emergency department use as evidence that these women receive inadequate prenatal care in terms of visit frequency. The study found that women with IDD had higher hospital utilization regardless of whether their prenatal care was deemed adequate or inadequate by standard metrics, suggesting the issue may lie in the accessibility or quality of care rather than the quantity of visits.