Introduction
This study examines prenatal care adequacy among women with physical, sensory, and
intellectual/developmental disabilities, compared with that among women without disabilities.
Methods
A population-based cohort study using linked health administrative data in Ontario,
Canada was completed. The study population comprised women with physical (n=83,752), sensory (n=25,685), intellectual/developmental (n=1,219), and multiple (n=4,966) disabilities and women without disabilities (n=953,766), with a birth in 2003–2017. Analyses were conducted in 2020. Women with
disabilities were identified using algorithms applied to healthcare encounters before
conception. The main outcome was prenatal care adequacy, measured using the Revised
Graduated Prenatal Care Utilization Index. Multivariable nominal logistic regression
was used to compute the AORs and 95% CIs for no, inadequate, and intensive (versus
adequate) care comparing each disability group with women without disabilities, adjusting
for sociodemographic and health characteristics.
Results
Women with physical disabilities, compared with those without disabilities, had increased
odds of intensive prenatal care (AOR=1.22, 95% CI=1.19, 1.24) and decreased odds of
no prenatal care (AOR=0.94, 95% CI=0.89, 0.99) versus adequate care. Women with sensory
disabilities had increased odds of intensive (AOR=1.11, 95% CI=1.08, 1.14), inadequate
(AOR=1.06, 95% CI=1.02, 1.09), and no (AOR=1.24, 95% CI=1.14, 1.35) prenatal care.
Women with intellectual/developmental disabilities had increased odds of inadequate
(AOR=1.25, 95% CI=1.08, 1.44) and no (AOR=1.64, 95% CI=1.16, 2.34) prenatal care.
Women with multiple disabilities had increased odds of intensive (AOR=1.41, 95% CI=1.32,
1.51) and inadequate (AOR=1.14, 95% CI=1.05, 1.22) prenatal care.
Conclusions
There are variations in prenatal care adequacy by maternal disability status. Disparities
in prenatal care access for women with disabilities, particularly those with intellectual/developmental
disabilities, need to be addressed.
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REFERENCES
- Pregnancy-related mortality from preeclampsia and eclampsia.Obstet Gynecol. 2001; 97: 533-538https://doi.org/10.1016/s0029-7844(00)01223-0
- The association of inadequate and intensive prenatal care with maternal, fetal, and infant outcomes: a population-based study in Manitoba, Canada.J Obstet Gynaecol Can. 2019; 41: 947-959https://doi.org/10.1016/j.jogc.2018.09.006
- Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a retrospective analysis of 28,729,765 U.S. deliveries over 8 years.Am J Perinatol. 2012; 29: 787-793https://doi.org/10.1055/s-0032-1316439
- Healthy Beginnings: Guidelines for Care During Pregnancy and Childbirth.Society of Obstetricians and Gynaecologists of Canada (SOGC), Ottawa, Canada1995
- Kilpatrick SJ Papile LA Macones GA Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics,
Itasca, IL2017https://ebooks.aappublications.org/content/9781610020886/9781610020886(Accessed July 9, 2021)Date accessed: July 9, 2021
- Role of prenatal care in preterm birth and low birthweight in Portugal.J Public Health Med. 1996; 18: 321-328https://doi.org/10.1093/oxfordjournals.pubmed.a024513
- Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba.BMC Pregnancy Childbirth. 2018; 18: 430https://doi.org/10.1186/s12884-018-2061-1
- Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review.Eur J Public Health. 2012; 22: 904-913https://doi.org/10.1093/eurpub/ckr164
- Timing and adequacy of prenatal care in the United States, 2016.Natl Vital Stat Rep. 2018; 67 (Accessed July 9, 2021): 1-14
- Pregnancy outcomes among women with intellectual and developmental disabilities.Am J Prev Med. 2015; 48: 300-308https://doi.org/10.1016/j.amepre.2014.09.032
- Prevalence and most common causes of disability among adults–United States, 2005.MMWR Morb Mortal Wkly Rep. 2009; 58 (Accessed July 9, 2021): 421-426
- A demographic, employment and income profile of Canadians with disabilities aged 15 years and over, 2017.Statistics Canada, Ottawa, CanadaNovember 28, 2018https://www150.statcan.gc.ca/n1/pub/89-654-x/89-654-x2018002-eng.htmDate accessed: July 9, 2021
- Rates of recognized pregnancy in women with disabilities in Ontario, Canada.Am J Obstet Gynecol. 2020; 222: 189-192https://doi.org/10.1016/j.ajog.2019.10.096
- Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis.Am J Obstet Gynecol. 2020; 222: 27.e1-27.e32https://doi.org/10.1016/j.ajog.2019.07.015
- Current evidence on antenatal care provision for women with intellectual disabilities: a systematic review.Midwifery. 2016; 32: 45-57https://doi.org/10.1016/j.midw.2015.10.002
- Health care access and support for disabled women in Canada: falling short of the UN Convention on the Rights of Persons with Disabilities: a qualitative study.Womens Health Issues. 2012; 22: e111-e118https://doi.org/10.1016/j.whi.2011.07.011
- We don’t know. We’ve never had anybody like you before”: barriers to perinatal care for women with physical disabilities.Disabil Health J. 2017; 10: 426-433https://doi.org/10.1016/j.dhjo.2017.03.017
- Differences in prenatal care by presence and type of maternal disability.Am J Prev Med. 2019; 56: 376-382https://doi.org/10.1016/j.amepre.2018.10.021
- Patterns of health care in Ontario.2nd edition. ICES, Toronto, CanadaMay 1996https://www.ices.on.ca/Publications/Atlases-and-Reports/1996/Patterns-of-health-care-2nd-ed(PublishedAccessed July 9, 2021)Date accessed: July 9, 2021
- Primary Cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.Womens Health Issues. 2017; 27: 336-344https://doi.org/10.1016/j.whi.2016.12.007
- Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms.J Intellect Disabil Res. 2013; 57: 462-477https://doi.org/10.1111/jir.12002
- Midwives and midwifery-led Births 2019.Canadian Association of Midwives, Montreal, CanadaOctober 1, 2020https://canadianmidwives.org/2020/10/01/registered-midwives-midwifery-assisted-births-2019/Date accessed: July 9, 2021
- Quantifying the adequacy of prenatal care: a comparison of indices.Public Health Rep. 1996; 111: 408-419https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381783/Date accessed: August 16, 2021
- Proliferation of prenatal ultrasonography.CMAJ. 2010; 182: 143-151https://doi.org/10.1503/cmaj.090979
- 2016 Ontario marginalization index: user guide.St. Michael’s Hospital, Public Health Ontario, Toronto, CanadaOctober 2018https://www.publichealthontario.ca/-/media/documents/on-marg-userguide.pdf?la=enDate accessed: July 9, 2021
- Measuring rurality - RIO2008 BASIC: Methodology and results.Ontario Medical Association. 2008;https://content.oma.org/wp-content/uploads/2008rio-fulltechnicalpaper.pdfDate accessed: August 16, 2021
- Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm.Diabetes Care. 2002; 25: 512-516https://doi.org/10.2337/diacare.25.3.512
- Accuracy of administrative databases in identifying patients with hypertension.Open Med. 2007; 1 (Accessed July 9, 2021): e18-e26
- Validity of administrative data for identifying patients who have had a stroke or transient ischemic attack using EMRALD as a reference standard.Can J Cardiol. 2013; 29: 1388-1394https://doi.org/10.1016/j.cjca.2013.07.676
- Identifying patients with atrial fibrillation in administrative data.Can J Cardiol. 2016; 32: 1561-1565https://doi.org/10.1016/j.cjca.2016.06.006
- Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.Chronic Dis Inj Can. 2013; 33: 160-166https://doi.org/10.24095/hpcdp.33.3.06
- Myocardial infarction and the validation of physician billing and hospitalization data using electronic medical records.Chronic Dis Can. 2010; 30: 141-146https://doi.org/10.24095/hpcdp.30.4.06
- Identifying patients with physician-diagnosed asthma in health administrative databases.Can Respir J. 2009; 16: 183-188https://doi.org/10.1155/2009/963098
- The Johns Hopkins ACG Case-Mix System Applications Guide Version 10.0.Johns Hopkins University, December 2011https://www.hopkinsacg.org/documents/system-documentation/Date accessed: August 16, 2021
- Validation of a population-based algorithm to detect chronic psychotic illness.Can J Psychiatry. 2015; 60: 362-368https://doi.org/10.1177/070674371506000805
- Using administrative data to measure ambulatory mental health service provision in primary care.Med Care. 2004; 42: 960-965https://doi.org/10.1097/00005650-200410000-00004
- Indices for continuity of care: a systematic review of the literature.Med Care Res Rev. 2006; 63: 158-188https://doi.org/10.1177/1077558705285294
- Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.Commun Stat Simul Comput. 2009; 38: 1228-1234https://doi.org/10.1080/03610910902859574
- Applied Logistic Regression.3rd ed. John Wiley & Sons, Inc., Hoboken, NJ2013https://doi.org/10.1002/9781118548387
- Pregnancy course, infant outcomes, rehospitalization, and mortality among women with intellectual disability.Disabil Health J. 2019; 12: 452-459https://doi.org/10.1016/j.dhjo.2019.01.004
- Health service use and outcomes among disabled Medicaid pregnant women.Womens Health Issues. 2006; 16: 313-322https://doi.org/10.1016/j.whi.2006.10.003
- Women with disability: the experience of maternity care during pregnancy, labour and birth and the postnatal period.BMC Pregnancy Childbirth. 2013; 13: 174https://doi.org/10.1186/1471-2393-13-174
- Deaf sign language users, health inequities, and public health: opportunity for social justice.Prev Chronic Dis. 2011; 8 (Accessed July 9, 2021): A45
- Impact of communication on preventive services among deaf American Sign Language users.Am J Prev Med. 2011; 41: 75-79https://doi.org/10.1016/j.amepre.2011.03.004
- Maternal intellectual or developmental disability and newborn discharge to protective services.Pediatrics. 2018; 142e20181416https://doi.org/10.1542/peds.2018-1416
- Sexual and reproductive health care for women with intellectual disabilities: a primary care perspective.Int J Family Med. 2013; 2013642472https://doi.org/10.1155/2013/642472
- Pregnancy in women with intellectual and developmental disabilities.J Obstet Gynaecol Can. 2016; 38: 9-16https://doi.org/10.1016/j.jogc.2015.10.004
- Access to and satisfaction with prenatal care among pregnant women with physical disabilities: findings from a national survey.J Womens Health (Larchmt). 2017; 26: 1356-1363https://doi.org/10.1089/jwh.2016.6297
- Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey.BMJ Open. 2017; 7e016757https://doi.org/10.1136/bmjopen-2017-016757
- Experiences of women with physical disabilities during the perinatal period: a review of the literature and recommendations to improve care.Health Care Women Int. 2015; 36: 88-107https://doi.org/10.1080/07399332.2013.815756
- The importance of preconception care for women with disabilities.Matern Child Health J. 2006; 10 (suppl): S175-S176https://doi.org/10.1007/s10995-006-0111-1
- Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care [published correction appears in Lancet. 2014;384(9948):1098].Lancet. 2014; 384: 1129-1145https://doi.org/10.1016/S0140-6736(14)60789-3
- Beyond (models of) disability?.J Med Philos. 2016; 41: 210-228https://doi.org/10.1093/jmp/jhv063
- Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.Public Health Rep. 2001; 116: 306-316https://doi.org/10.1093/phr/116.4.306
- Women's and care providers’ perspectives of quality prenatal care: a qualitative descriptive study.BMC Pregnancy Childbirth. 2012; 12: 29https://doi.org/10.1186/1471-2393-12-29
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Published online: August 20, 2021
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