番茄社区

Newborns of mothers with disabilities were found to be at mildly to moderately increased risk of several birth complications, a cohort study reported.

Infants of mothers with intellectual or development disability were at higher risk of several outcomes compared with those born to mothers without any diagnosed disabilities:

• Preterm birth at less than 37 weeks (RR 1.37, 95% CI 1.19-1.58)
• Small for gestational age (RR 1.37, 95% CI 1.24-1.59)
• Neonatal morbidity (1.42, 95% CI 1.27-1.60)
• Neonatal abstinence syndrome (1.53, 95% CI 1.12-2.08)
• Neonatal ICU (NICU) admission (1.53, 95% CI 1.40-1.67)

Newborns of mothers with two or more disabilities had similar magnitudes of these elevated risks, epidemiologist Hilary Brown, PhD, from University of Toronto Scarborough, Ontario, and colleagues reported in a study in .

"These findings have important implications for health care providers, particularly since many of the outcomes we looked at, like preterm birth, can be prevented through better access to high-quality preconception and prenatal care," Brown told 番茄社区.

Preterm birth is associated with a number of conditions that may take years to manifest. In another study co-authored by Brown, being only a few weeks preterm was associated with worse cardiometabolic outcomes by 3 to 12 years of age. That found that being born preterm as late as week 36 was associated with an increased cardiometabolic risk score comprising standardized waist circumference, triglycerides, glucose, systolic blood pressure, and HDL cholesterol.

"Our data also show the need to consider the physical, communication, and other accommodation needs of disabled mothers in newborn health care spaces like NICUs and pediatricians' offices," Brown said. "Many NICUs, for example, are not set up to accommodate wheelchairs."

"Most importantly, these findings show the need for pediatricians and other healthcare providers to receive training and resources to better understand the needs of mothers with disabilities," she emphasized.

In an , neonatologist Kathleen Hannan, MD, of the University of Colorado in Aurora, and colleagues suggested adapting existing perinatal programs to meet the needs of pregnant women with disabilities.

They cited one such project, the , which begins maternal home visits early in pregnancy and continues in the postnatal period for mothers with risk factors such as young age, single-parent status, or low socioeconomic status.

The present population-based cohort study collected data on all singleton live births from all hospitals in Ontario from 2003 to 2018.

Included were over 200,000 newborns born to mothers with physical, sensory, intellectual, or multiple disabilities. They were compared with a cohort of over 1.5 million babies born to women without any recognized disability.

Birth risks were adjusted for social, heath, and health care characteristics. Nevertheless, unmeasured confounding factors may have affected results. There was a lack of data on individual socioeconomic status, and study authors acknowledged that they did not consider functional limitations outside diagnosed disabilities.

Hannan's group pointed out that maternal birth status (i.e., whether women were themselves born preterm) and relationship status were not included in the study.

"Overall, this study highlights the need for ongoing research to identify the barriers and facilitators to improve birth outcomes among women with disabilities," according to the editorialists.

"Moreover, further work is needed to identify and measure the potential additive or exponential impact of disabilities in the birthing population when combined with other known perinatal risk factors," they said.

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