Rapid repeat pregnancy among women with intellectual and developmental disabilities: a population-based cohort study

Abstract

Background: Rapid repeat pregnancy within 12 months of a live birth is associated with adverse perinatal outcomes. We evaluated the risk for rapid repeat pregnancy among women with intellectual and developmental disabilities, with whom sharing of information about pregnancy planning and contraception may be inadequate.

Methods: We accessed population-based health administrative data for all women with an index live birth in Ontario, Canada, for the period 2002-2013. We used modified Poisson regression to compare relative risks (RRs) for a rapid repeat pregnancy within 12 months of the index live birth in women with and without intellectual and developmental disabilities, first adjusting for demographic factors and then additionally adjusting for social, health and health care disparities.

Results: We compared 2855 women with intellectual and developmental disabilities and 923 367 women without such disabilities. At the index live birth, women with intellectual and developmental disabilities were more likely to be younger than 25 years of age (46.8% v. 18.2%) and to be disadvantaged on each measure of social, health and health care disparities. These women had a higher rate of rapid repeat pregnancy than those without such disabilities (7.6% v. 3.9%; adjusted RR 1.34, 95% confidence interval [CI] 1.18-1.54, after controlling for demographic factors). This risk was attenuated upon further adjustment for social, health and health care disparities (adjusted RR 1.00, 95% CI 0.87-1.14).

Interpretation: Rapid repeat pregnancy, which was more common among women with intellectual and developmental disabilities, may be explained by social, health and health care disparities. To optimize reproductive health, multifactorial approaches to address the marginalization experienced by this population are likely needed.

Figure 1:

Cumulative incidence of rapid repeat pregnancy occurring within 12 months of a prior live birth, among women with (thick dashed line) and without (dotted line) intellectual and developmental disabilities. To avoid misclassification of complications from the index live birth as a rapid repeat pregnancy, rapid repeat pregnancies were counted starting at 3 months after the index live birth. Because of the small number of events among women with intellectual and developmental disabilities, the data for 3 and 4 months are combined, to protect individuals’ privacy.

Figure 2:

Adjusted risk of rapid repeat pregnancy occurring within 12 months of a prior live birth among women with and without intellectual and developmental disabilities (IDDs), stratified by factors expected to directly affect the risk of rapid repeat pregnancy. Data are presented as number (%) of rapid repeat pregnancies among women with and without IDDs, adjusted relative risks (RRs) and 95% confidence intervals (CIs) for associations, and p values for interaction terms between disability status and effect modifiers. Adjusted stratified models controlled for all variables except that used for stratification, from among age, parity, urban residence, neighbourhood income quintile, social assistance, stable and unstable chronic medical conditions, mental illness and continuity of primary care. Note: ref = reference.