Prenatal Care Adequacy Among Women With Disabilities: A Population-Based Study

  • Fareha Nishat
    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada
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  • Yona Lunsky
    ICES, Toronto, Ontario, Canada

    Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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  • Lesley A. Tarasoff
    Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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  • Hilary K. Brown
    Address correspondence to: Hilary K. Brown, PhD, Department of Health & Society, University of Toronto Scarborough, 1265 Military Trail, Toronto Ontario M1C 1A5, Canada.
    Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    ICES, Toronto, Ontario, Canada

    Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
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      This study examines prenatal care adequacy among women with physical, sensory, and intellectual/developmental disabilities, compared with that among women without disabilities.


      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.


      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.


      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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