PDF(Pubmed)
Abstract：
UNASSIGNED: Small, geographically limited studies report that people with intellectual and developmental disabilities (IDD) have increased risk for serious pregnancy-related and birth-related challenges, including preeclampsia, preterm birth, and increased anxiety and depression, than their peers. United States-based population-level data among people with IDD are lacking.
UNASSIGNED: To identify perinatal and postpartum outcomes among a national, longitudinal sample of people with IDD enrolled in public health insurance, compare subgroups of people with IDD, and compare outcomes among people with IDD with those of peers without IDD.
UNASSIGNED: This retrospective cohort study used national Medicaid claims from January 1, 2008, to December 31, 2019, for 55 440 birthing people with IDD and a random sample of 438 557 birthing people without IDD. Medicaid funds almost half of all births and is the largest behavioral health insurer in the US, covering a robust array of services for people with IDD. Statistical analysis was performed from July 2023 to June 2024.
UNASSIGNED: People who had a documented birth in Medicaid during the study years.
UNASSIGNED: Perinatal outcomes were compared across groups using univariate and multivariate logistic regression. The probability of postpartum anxiety and depression was estimated using Kaplan-Meier and Cox proportional hazards regression.
UNASSIGNED: The study sample included 55 440 birthing people with IDD (including 41 854 with intellectual disabilities [ID] and 13 586 with autism; mean [SD] age at first delivery, 24.9 [6.7] years) and a random sample of 438 557 birthing people without IDD (mean [SD] age at first delivery, 26.4 [6.3] years). People with IDD were younger at first observed delivery, had a lower prevalence of live births (66.6% vs 76.7%), and higher rates of obstetric conditions (gestational diabetes, 10.3% vs 9.9%; gestational hypertension, 8.7% vs 6.1%; preeclampsia, 6.1% vs 4.4%) and co-occurring physical conditions (heart failure, 1.4% vs 0.4%; hyperlipidemia, 5.3% vs 1.7%; ischemic heart disease, 1.5% vs 0.4%; obesity, 16.3% vs 7.4%) and mental health conditions (anxiety disorders, 27.9% vs 6.5%; depressive disorders, 32.1% vs 7.5%; posttraumatic stress disorder, 9.5% vs 1.2%) than people without IDD. The probability of postpartum anxiety (adjusted hazard ratio [AHR], 3.2 [95% CI, 2.9-3.4]) and postpartum depression (AHR, 2.4 [95% CI, 2.3-2.6]) was significantly higher among autistic people compared with people with ID only and people without IDD.
UNASSIGNED: In this retrospective cohort study, people with IDD had a younger mean age at first delivery, had lower prevalence of live births, and had poor obstetric, mental health, and medical outcomes compared with people without IDD, pointing toward a need for clinician training and timely delivery of maternal health care. Results highlight needed reproductive health education, increasing clinician knowledge, and expanding Medicaid to ensure access to care for people with IDD.
UNASSIGNED: To identify perinatal and postpartum outcomes among a national, longitudinal sample of people with IDD enrolled in public health insurance, compare subgroups of people with IDD, and compare outcomes among people with IDD with those of peers without IDD.
UNASSIGNED: This retrospective cohort study used national Medicaid claims from January 1, 2008, to December 31, 2019, for 55 440 birthing people with IDD and a random sample of 438 557 birthing people without IDD. Medicaid funds almost half of all births and is the largest behavioral health insurer in the US, covering a robust array of services for people with IDD. Statistical analysis was performed from July 2023 to June 2024.
UNASSIGNED: People who had a documented birth in Medicaid during the study years.
UNASSIGNED: Perinatal outcomes were compared across groups using univariate and multivariate logistic regression. The probability of postpartum anxiety and depression was estimated using Kaplan-Meier and Cox proportional hazards regression.
UNASSIGNED: The study sample included 55 440 birthing people with IDD (including 41 854 with intellectual disabilities [ID] and 13 586 with autism; mean [SD] age at first delivery, 24.9 [6.7] years) and a random sample of 438 557 birthing people without IDD (mean [SD] age at first delivery, 26.4 [6.3] years). People with IDD were younger at first observed delivery, had a lower prevalence of live births (66.6% vs 76.7%), and higher rates of obstetric conditions (gestational diabetes, 10.3% vs 9.9%; gestational hypertension, 8.7% vs 6.1%; preeclampsia, 6.1% vs 4.4%) and co-occurring physical conditions (heart failure, 1.4% vs 0.4%; hyperlipidemia, 5.3% vs 1.7%; ischemic heart disease, 1.5% vs 0.4%; obesity, 16.3% vs 7.4%) and mental health conditions (anxiety disorders, 27.9% vs 6.5%; depressive disorders, 32.1% vs 7.5%; posttraumatic stress disorder, 9.5% vs 1.2%) than people without IDD. The probability of postpartum anxiety (adjusted hazard ratio [AHR], 3.2 [95% CI, 2.9-3.4]) and postpartum depression (AHR, 2.4 [95% CI, 2.3-2.6]) was significantly higher among autistic people compared with people with ID only and people without IDD.
UNASSIGNED: In this retrospective cohort study, people with IDD had a younger mean age at first delivery, had lower prevalence of live births, and had poor obstetric, mental health, and medical outcomes compared with people without IDD, pointing toward a need for clinician training and timely delivery of maternal health care. Results highlight needed reproductive health education, increasing clinician knowledge, and expanding Medicaid to ensure access to care for people with IDD.
摘要：
■小，地理上有限的研究报告说，智力和发育障碍（IDD）的人增加了与怀孕和分娩有关的严重挑战的风险，包括先兆子痫,早产,焦虑和抑郁加剧，比他们的同龄人。缺乏基于美国的IDD患者的人口水平数据。
■为了确定全国围产期和产后结局，参加公共医疗保险的碘缺乏病患者的纵向样本，比较患有IDD的人群的亚组，并比较患有IDD的人与没有IDD的同龄人的结果。
■这项回顾性队列研究使用了2008年1月1日至2019年12月31日的国家医疗补助索赔，对55440名患有IDD的分娩者和438557名没有IDD的分娩者进行了随机抽样。医疗补助为几乎一半的新生儿提供资金，是美国最大的行为健康保险公司，为IDD患者提供一系列强大的服务。统计分析于2023年7月至2024年6月进行。
■在研究期间有记录出生的人。
■使用单变量和多变量逻辑回归比较各组围产期结局。使用Kaplan-Meier和Cox比例风险回归估计产后焦虑和抑郁的概率。
■研究样本包括55440名患有IDD的分娩者（包括41854名智力残疾[ID]和13586名自闭症患者；首次分娩时的平均[SD]年龄，24.9[6.7]年）和438557个无IDD分娩者的随机样本（首次分娩时的平均[SD]年龄，26.4[6.3]年）。初次观察分娩时，IDD患者较年轻，活产率较低(66.6%vs76.7%)，和更高的产科疾病发病率(妊娠期糖尿病，10.3％vs9.9％；妊娠期高血压，8.7%vs6.1%；先兆子痫，6.1%vs4.4%)和同时发生的身体状况(心力衰竭，1.4%vs0.4%；高脂血症，5.3%vs1.7%；缺血性心脏病，1.5%vs0.4%；肥胖，16.3%vs7.4%)和精神健康状况(焦虑症，27.9%vs6.5%；抑郁症，32.1%vs7.5%；创伤后应激障碍，9.5%vs1.2%）比没有IDD的人。产后焦虑的可能性(调整后的危险比[AHR]，3.2[95%CI，2.9-3.4]）和产后抑郁症（AHR，2.4[95％CI，2.3-2.6]）与仅有ID的人和无IDD的人相比，在自闭症患者中明显更高。
■在这项回顾性队列研究中，患有IDD的人在首次分娩时的平均年龄较小，活产的患病率较低，产科不良，心理健康,以及与没有碘缺乏病的人相比的医疗结果，指出需要对临床医生进行培训并及时提供孕产妇保健服务。结果突出了需要的生殖健康教育，增加临床医生的知识，并扩大医疗补助计划，以确保IDD患者获得护理。
■为了确定全国围产期和产后结局，参加公共医疗保险的碘缺乏病患者的纵向样本，比较患有IDD的人群的亚组，并比较患有IDD的人与没有IDD的同龄人的结果。
■这项回顾性队列研究使用了2008年1月1日至2019年12月31日的国家医疗补助索赔，对55440名患有IDD的分娩者和438557名没有IDD的分娩者进行了随机抽样。医疗补助为几乎一半的新生儿提供资金，是美国最大的行为健康保险公司，为IDD患者提供一系列强大的服务。统计分析于2023年7月至2024年6月进行。
■在研究期间有记录出生的人。
■使用单变量和多变量逻辑回归比较各组围产期结局。使用Kaplan-Meier和Cox比例风险回归估计产后焦虑和抑郁的概率。
■研究样本包括55440名患有IDD的分娩者（包括41854名智力残疾[ID]和13586名自闭症患者；首次分娩时的平均[SD]年龄，24.9[6.7]年）和438557个无IDD分娩者的随机样本（首次分娩时的平均[SD]年龄，26.4[6.3]年）。初次观察分娩时，IDD患者较年轻，活产率较低(66.6%vs76.7%)，和更高的产科疾病发病率(妊娠期糖尿病，10.3％vs9.9％；妊娠期高血压，8.7%vs6.1%；先兆子痫，6.1%vs4.4%)和同时发生的身体状况(心力衰竭，1.4%vs0.4%；高脂血症，5.3%vs1.7%；缺血性心脏病，1.5%vs0.4%；肥胖，16.3%vs7.4%)和精神健康状况(焦虑症，27.9%vs6.5%；抑郁症，32.1%vs7.5%；创伤后应激障碍，9.5%vs1.2%）比没有IDD的人。产后焦虑的可能性(调整后的危险比[AHR]，3.2[95%CI，2.9-3.4]）和产后抑郁症（AHR，2.4[95％CI，2.3-2.6]）与仅有ID的人和无IDD的人相比，在自闭症患者中明显更高。
■在这项回顾性队列研究中，患有IDD的人在首次分娩时的平均年龄较小，活产的患病率较低，产科不良，心理健康,以及与没有碘缺乏病的人相比的医疗结果，指出需要对临床医生进行培训并及时提供孕产妇保健服务。结果突出了需要的生殖健康教育，增加临床医生的知识，并扩大医疗补助计划，以确保IDD患者获得护理。
