(649) Deliveries with a disability diagnosis and risk for adverse maternal outcomes in the U.S., 2000-2021

Objective: There is limited data on pregnancy outcomes of people with disabilities. People with disabilities are more likely to have chronic conditions and adverse social determinants of health, which are risk factors for pregnancy complications. We evaluated the association between disability diagnosis and severe maternal morbidity (SMM) and other adverse outcomes.

Study Design: We conducted a serial cross-sectional analysis of delivery hospitalizations with a physical, intellectual or sensory disability diagnosis in the National Inpatient Sample during 2000-2021. Our primary outcome was non-transfusion SMM. Secondary outcomes were transfusion, hypertensive disorders of pregnancy (HDP), preterm delivery (PTD), and maternal death. We described temporal trends in SMM by presence of any disability, reporting average annual percent change (AAPC). We fit logistic regression models to evaluate the association between any disability and our outcomes, adjusting for demographic and obstetric factors and chronic conditions. In subgroup analyses, we evaluated risk for SMM by disability type.

Results: Of 83.7 million total deliveries, 857,876 (1.0%) had a disability diagnosis, with 83.8% of disabilities physical, 6.0% intellectual, and 10.2% sensory. Deliveries with any disability had threefold higher risk of SMM (2.7% vs 0.7%; adjusted OR [aOR] 3.33, 95% CI 3.22, 3.44) as well as higher risk for transfusion (aOR 2.02, 95% CI 1.94, 2.09), HDP (aOR 1.50, 95% CI 1.47, 1.52), PTD (aOR 1.38, 95% CI 1.36, 1.41) and death (unadjusted OR 8.26, 95% CI 6.43, 10.61). Risk for SMM was elevated across all disability types but highest in the setting of physical disability (aOR 3.37, 95% CI 3.25, 3.49). Incidence of SMM among deliveries with any disability increased from 2000 to 2021 (AAPC 3.1%, 95% CI 2.4%, 3.8%).

Conclusion: Pregnant people with disabilities have threefold higher risk of SMM, even after adjusting for social risk factors and chronic disease. This risk persists across all disability types and is increasing over time. Future research is needed to develop interventions to improve pregnancy outcomes in this population.