Intellectual and Developmental Disabilities May Pose Perinatal Health Risks

People with intellectual and developmental disabilities (IDD) have a younger mean age at first delivery and a higher risk for medical and mental health conditions relative to those without IDD, according to new research published in JAMA Network Open.

Individuals with IDD are affected by neurodevelopmental differences in intellectual functioning, adaptive behavior, and social interactions, which in turn may decrease the effectiveness and efficiency of health care systems and medical professionals’ ability to provide quality care. Currently, little is known about maternal and infant health outcomes among people with IDD.

To identify prenatal, childbirth, and postpartum outcomes among birthing people with IDD, investigators conducted a retrospective cohort study using data from the Centers for Medicare & Medicaid Services (CMS). The investigators identified all Medicaid enrollees with IDD, including those with an autism spectrum disorder (ASD) and/or intellectual disability. The comparison group for the study consisted of a randomly selected sample of Medicaid enrollees without IDD.

The investigators examined medical claims related to live births, miscarriages, stillbirths, terminations, and unknown outcomes during the perinatal period. For obstetric outcomes, the study focused on the 275 days immediately before and after the delivery endpoint; for co-occurring physical and mental health conditions, this time frame was extended to 1 year before and after the delivery endpoint.

A total of 55,440 birthing people with IDD and 438,557 birthing people without IDD were included in the analysis. The mean (SD) age at first delivery was 24.9 (6.7) years for the IDD cohort and 26.4 (6.3) years for the control cohort. Among the individuals with IDD, 47.5% were White, 32.1% were Black, and 11.9% were Hispanic or Latino.

Nearly half (46.2%) of birthing people with ASD delivered before 21 years of age. The prevalence of live births was significantly lower among those with IDD (66.6%), relative to people without IDD (76.7%). Additionally, miscarriages, stillbirths, and terminations were more common in people with IDD (19.5%) compared with the control cohort (15.3%).

Relative to the control cohort, birthing people with IDD had higher proportions of obstetric, physical, and mental health conditions across all outcomes evaluated. Following multivariable adjustment, the IDD cohort had higher odds of experiencing each adverse outcome, including gestational diabetes (adjusted odds ratio [aOR], 1.13; 95% CI, 1.09-1.17), gestational hypertension (aOR, 1.15; 95% CI, 1.10-1.20), preeclampsia (aOR, 1.17; 95% CI, 1.12-1.23), heart failure (aOR, 1.84; 95% CI, 1.63-2.07), hyperlipidemia (aOR, 2.17; 95% CI, 2.04-2.32), obesity (aOR, 1.55; 95% CI, 1.50-1.60), anxiety disorders (aOR, 2.94; 95% CI, 2.85-3.03), depressive disorders (aOR, 3.26; 95% CI, 3.17-3.36), schizophrenia (aOR, 8.90; 95% CI, 8.24-9.61), and bipolar disorder (aOR, 4.55; 95% CI, 4.39-4.72).

These results indicate that relative to those without IDD, birthing people with IDD are younger at the time of first delivery, have fewer live births, and have higher rates of obstetric and comorbid physical and mental health conditions before and after delivery. “Findings from this cohort study present a need to tailor reproductive health education, perinatal care, and delivery services to ensure comprehensive and targeted support for birthing people with IDD,” the investigators concluded. “Designing and implementing policies aligned with and guided by the needs of people with IDD can lead to reductions in maternal health disparities.”

The primary study limitation is the reliance on medical claims data, which may contribute to selection bias and underreporting of birthing outcomes.  

This article originally appeared on Psychiatry Advisor