Oral Concurrent Session 5 - Hypertension
Oral Concurrent Sessions
Manasa G. Rao, MD
Resident Physician
Columbia University Medical Center
New York, New York, United States
Timothy Wen, MD, MPH (he/him/his)
Assistant Professor
University of California, San Diego
Irvine, California, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief
Willard C. Rappleye Professor and Chair
Columbia University Medical Center
New York, New York, United States
Alexander M. Friedman, MD, MPH
Professor of Obstetrics and Gynecology
Columbia University Irving Medical Center
New York, New York, United States
Noelia Zork, MD
Associate Professor of Obstetrics and Gynecology, Director of the Diabetes in Pregnancy Program
Columbia University Irving Medical Center
New York, New York, United States
People with intellectual and developmental disabilities (IDD) have higher risk for obesity, diabetes, asthma, and cardiovascular disease. There is limited contemporary data on pregnancy outcomes in the setting of IDD. The objective of this study was to evaluate whether IDD is associated with adverse perinatal outcomes in a large national sample.
Study Design: Delivery hospitalizations to patients aged 15-54 were analyzed using the 2000-2021 Nationwide Inpatient Sample. Primary exposure of interest was IDD, defined using ICD9/ICD10 codes. Temporal trends in proportion of deliveries with IDD were analyzed with joint point regression to determine average annual percent change (AAPC) with 95% confidence intervals. Adjusted logistic regression models were performed for outcomes accounting for hospital, demographic, and clinical factors with IDD as the exposure of interest.
Results: Of 83.6 million births, 23,347 (0.03%) had an associated IDD diagnosis. Deliveries to patients with IDD increased from 1 per 10,000 in 2000 to 6 per 10,000 in 2021 (AAPC 7.7%, 95% CI: 1.0%-8.8%, p< 0.01). IDD deliveries were more likely to have a diagnosis of obesity (p< 0.01), asthma (p< 0.01), chronic hypertension (p< 0.01), pregestational and gestational diabetes (p< 0.01), or a mental health condition (p< 0.01). In adjusted analyses, IDD deliveries were more likely to have preterm birth at < 37 (aOR 1.5, 1.3-1.7), < 34 (aOR 1.7, 1.4-2.0), < 32 weeks (aOR 1.7, 1.4-2.1), cesarean delivery (aOR 1.6, 1.5-1.8), operative vaginal delivery (aOR 1.6, 1.4-1.8), non-transfusion severe maternal morbidity (aOR 1.7, 1.4-2.1), transfusion (aOR 1.34, 1.09-1.65), hypertensive disorders of pregnancy (aOR 1.2, 1.1-1.3), postpartum hemorrhage (aOR 1.2, 1.1-1.4), infection (aOR 1.2, 1.0-1.4), and stillbirth (aOR 2.3, 1.9-2.8). Likelihood of placental abruption and infection were not significantly different between groups.
Conclusion:
IDD among delivery hospitalizations is increasing and is associated with adverse perinatal outcomes. Additional resources and surveillance may be warranted for patients with IDD to optimize outcomes.
