Pregnancy Risks Are Higher For Women With Intellectual Disabilities

What was studied

This study looked at pregnancy outcomes in women with intellectual disabilities in California. Researchers used linked state records from 2007 to 2020, including birth and fetal death records plus hospital discharge, emergency department, and ambulatory surgery data. They focused on singleton births and compared women with intellectual disabilities to similar women without intellectual disabilities.

The main analysis included 1,107 women with intellectual disabilities and 33,174 women without intellectual disabilities after matching on factors such as age, race/ethnicity, insurance payer, WIC participation, birth year, and whether the mother was born in the US. The study examined severe maternal morbidity, preeclampsia, and gestational hypertension, and also assessed whether selected health conditions or behavioral risk factors might help explain the higher risks.

What they found

Women with intellectual disabilities had higher rates of inadequate prenatal care, substance use disorders during pregnancy, mental health conditions, and chronic health problems such as epilepsy, preexisting hypertension, preexisting diabetes, respiratory conditions, and thyroid disease.

Compared with matched women without intellectual disabilities, women with intellectual disabilities had higher risks of serious pregnancy complications. The adjusted excess risk was about 3 more cases of severe maternal morbidity per 100 deliveries, about 7.8 more cases of preeclampsia per 100 deliveries, and about 6.9 more cases of gestational hypertension per 100 deliveries. Adjusted risk ratios were also higher: 2.7 for severe maternal morbidity, 2.8 for preeclampsia, and 2.0 for gestational hypertension.

The researchers estimated that the measured health conditions and behavioral risk factors together explained about one-quarter to one-third of the association. In single-mediator analyses, epilepsy accounted for the greatest proportion for severe maternal morbidity, preexisting hypertension for preeclampsia, and anxiety for gestational hypertension.

Limits of the evidence

This was an observational study based on medical records and diagnosis codes, so it cannot show from this design alone that intellectual disability itself caused these outcomes. The results may be affected by coding errors, missed diagnoses, or differences in how conditions were recorded at delivery.

The study only included births in California and a relatively small number of women with intellectual disabilities, so results may not fully apply everywhere. The mediation results are estimates and do not show that changing one factor would necessarily reduce risk by the same amount. The abstract also does not give details about severity or type of intellectual disability, epilepsy treatment, or quality of prenatal care.

For families and caregivers

For families, this study suggests that pregnant women with intellectual disabilities may face higher risks of serious pregnancy complications and high blood pressure disorders in pregnancy. It also suggests that some of this higher risk may be related to health conditions and behavioral risk factors measured in the study, such as epilepsy, chronic hypertension, mental health conditions, and substance use.

This does not mean these outcomes will happen to every person with an intellectual disability. It suggests that pre-pregnancy planning, prenatal care, and attention to chronic conditions may be important topics to discuss with a clinician.

What to watch next

Future studies could test whether targeted preconception and prenatal interventions are associated with lower pregnancy risks in this population.

Terms in this summary

intellectual disability

A condition that affects learning, reasoning, and everyday functioning and begins during development.

severe maternal morbidity

Serious health problems during labor or delivery that can have major short-term or long-term effects on the mother.

preeclampsia

A pregnancy complication marked by high blood pressure and signs that organs such as the kidneys or liver may be affected.

gestational hypertension

High blood pressure that starts during pregnancy.

mediator

A factor that may help explain part of the link between one condition and an outcome.

risk ratio

A comparison of how often an outcome happens in one group versus another.