Advertisement

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

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

    ICES, Toronto, Ontario, Canada
    Search for articles by this author
  • Yona Lunsky
    Affiliations
    ICES, Toronto, Ontario, Canada

    Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
    Search for articles by this author
  • Lesley A. Tarasoff
    Affiliations
    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
    Search for articles by this author
  • Hilary K. Brown
    Correspondence
    Address correspondence to: Hilary K. Brown, PhD, Department of Health & Society, University of Toronto Scarborough, 1265 Military Trail, Toronto Ontario M1C 1A5, Canada.
    Affiliations
    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
    Search for articles by this author

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • MacKay AP
        • Berg CJ
        • Atrash HK
        Pregnancy-related mortality from preeclampsia and eclampsia.
        Obstet Gynecol. 2001; 97: 533-538https://doi.org/10.1016/s0029-7844(00)01223-0
        • Heaman MI
        • Martens PJ
        • Brownell MD
        • Chartier MJ
        • Derksen SA
        • Helewa ME
        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
        • Partridge S
        • Balayla J
        • Holcroft CA
        • Abenhaim HA
        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
        • Society of Obstetricians and Gynaecologists of Canada (SOGC)
        Healthy Beginnings: Guidelines for Care During Pregnancy and Childbirth.
        Society of Obstetricians and Gynaecologists of Canada (SOGC), Ottawa, Canada1995
      1. Kilpatrick SJ Papile LA Macones GA Guidelines for Perinatal Care. 8th ed. American Academy of Pediatrics, Itasca, IL2017 (Accessed July 9, 2021)
        • Barros H
        • Tavares M
        • Rodrigues T
        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
        • Heaman MI
        • Martens PJ
        • Brownell MD
        • et al.
        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
        • Feijen-de Jong EI
        • Jansen DE
        • Baarveld F
        • van der Schans CP
        • Schellevis FG
        • Reijneveld SA
        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
        • Osterman MJK
        • Martin JA.
        Timing and adequacy of prenatal care in the United States, 2016.
        Natl Vital Stat Rep. 2018; 67 (Accessed July 9, 2021): 1-14
        • Mitra M
        • Parish SL
        • Clements KM
        • Cui X
        • Diop H
        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
        • Centers for Disease Control and Prevention (CDC)
        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
        • Morris S
        • Fawcett G
        • Brisebois L
        • Hughes J
        A demographic, employment and income profile of Canadians with disabilities aged 15 years and over, 2017.
        Statistics Canada, Ottawa, CanadaNovember 28, 2018
        • Brown HK
        • Chen S
        • Guttmann A
        • et al.
        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
        • Tarasoff LA
        • Ravindran S
        • Malik H
        • Salaeva D
        • Brown HK
        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
        • Homeyard C
        • Montgomery E
        • Chinn D
        • Patelarou E
        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
        • Gibson BE
        • Mykitiuk R
        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
        • Tarasoff LA
        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
        • Horner-Johnson W
        • Biel FM
        • Caughey AB
        • Darney BG
        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
        • Goel V
        • Williams J
        • Anderson G
        • Blackstien-Hirsch P
        • Fooks C
        • Naylor CD
        Patterns of health care in Ontario.
        2nd edition. ICES, Toronto, CanadaMay 1996 (PublishedAccessed July 9, 2021)
        • Darney BG
        • Biel FM
        • Quigley BP
        • Caughey AB
        • Horner-Johnson W
        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
        • Lin E
        • Balogh R
        • Cobigo V
        • Ouellette-Kuntz H
        • Wilton AS
        • Lunsky Y
        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
        • Canadian Association of Midwives
        Midwives and midwifery-led Births 2019.
        Canadian Association of Midwives, Montreal, CanadaOctober 1, 2020
        • Alexander GR
        • Kotelchuck M
        Quantifying the adequacy of prenatal care: a comparison of indices.
        Public Health Rep. 1996; 111: 408-419
        • You JJ
        • Alter DA
        • Stukel TA
        • et al.
        Proliferation of prenatal ultrasonography.
        CMAJ. 2010; 182: 143-151https://doi.org/10.1503/cmaj.090979
        • Matheson FI
        • van Ingen T
        2016 Ontario marginalization index: user guide.
        St. Michael’s Hospital, Public Health Ontario, Toronto, CanadaOctober 2018
        • Kralj B
        Measuring rurality - RIO2008 BASIC: Methodology and results.
        Ontario Medical Association. 2008;
        • Hux JE
        • Ivis F
        • Flintoft V
        • Bica A
        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
        • Tu K
        • Campbell NR
        • Chen ZL
        • Cauch-Dudek KJ
        • McAlister FA
        Accuracy of administrative databases in identifying patients with hypertension.
        Open Med. 2007; 1 (Accessed July 9, 2021): e18-e26
        • Tu K
        • Wang M
        • Young J
        • et al.
        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
        • Tu K
        • Nieuwlaat R
        • Cheng SY
        • et al.
        Identifying patients with atrial fibrillation in administrative data.
        Can J Cardiol. 2016; 32: 1561-1565https://doi.org/10.1016/j.cjca.2016.06.006
        • Schultz SE
        • Rothwell DM
        • Chen Z
        • Tu K
        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
        • Tu K
        • Mitiku T
        • Guo H
        • Lee DS
        • Tu JV
        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
        • Gershon AS
        • Wang C
        • Guan J
        • Vasilevska-Ristovska J
        • Cicutto L
        • To T
        Identifying patients with physician-diagnosed asthma in health administrative databases.
        Can Respir J. 2009; 16: 183-188https://doi.org/10.1155/2009/963098
        • Johns Hopkins University
        The Johns Hopkins ACG Case-Mix System Applications Guide Version 10.0.
        Johns Hopkins University, December 2011
        • Kurdyak P
        • Lin E
        • Green D
        • Vigod S
        Validation of a population-based algorithm to detect chronic psychotic illness.
        Can J Psychiatry. 2015; 60: 362-368https://doi.org/10.1177/070674371506000805
        • Steele LS
        • Glazier RH
        • Lin E
        • Evans M
        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
        • Jee SH
        • Cabana MD.
        Indices for continuity of care: a systematic review of the literature.
        Med Care Res Rev. 2006; 63: 158-188https://doi.org/10.1177/1077558705285294
        • Austin PC
        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
        • Hosmer DW
        • Lemeshow S
        • Sturdivant RX.
        Applied Logistic Regression.
        3rd ed. John Wiley & Sons, Inc., Hoboken, NJ2013https://doi.org/10.1002/9781118548387
        • Mueller BA
        • Crane D
        • Doody DR
        • Stuart SN
        • Schiff MA
        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
        • Gavin NI
        • Benedict MB
        • Adams EK
        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
        • Redshaw M
        • Malouf R
        • Gao H
        • Gray R
        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
        • Barnett S
        • McKee M
        • Smith SR
        • Pearson TA
        Deaf sign language users, health inequities, and public health: opportunity for social justice.
        Prev Chronic Dis. 2011; 8 (Accessed July 9, 2021): A45
        • McKee MM
        • Barnett SL
        • Block RC
        • Pearson TA
        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
        • Brown HK
        • Potvin LA
        • Lunsky Y
        • Vigod SN
        Maternal intellectual or developmental disability and newborn discharge to protective services.
        Pediatrics. 2018; 142e20181416https://doi.org/10.1542/peds.2018-1416
        • Greenwood NW
        • Wilkinson J
        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
        • Brown HK
        • Lunsky Y
        • Wilton AS
        • Cobigo V
        • Vigod SN
        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
        • Mitra M
        • Akobirshoev I
        • Moring NS
        • et al.
        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
        • Malouf R
        • Henderson J
        • Redshaw M
        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
        • Tarasoff LA
        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
        • Thierry JM.
        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
        • Renfrew MJ
        • McFadden A
        • Bastos MH
        • et al.
        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
        • Beaudry JS
        Beyond (models of) disability?.
        J Med Philos. 2016; 41: 210-228https://doi.org/10.1093/jmp/jhv063
        • Alexander GR
        • Kotelchuck M
        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
        • Sword W
        • Heaman MI
        • Brooks S
        • et al.
        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