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Meta-Analysis
. 2020 Jan;222(1):27.e1-27.e32.
doi: 10.1016/j.ajog.2019.07.015. Epub 2019 Jul 12.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

Lesley A Tarasoff  1 , Saranyah Ravindran  2 , Hannan Malik  3 , Dinara Salaeva  2 , Hilary K Brown  4
Affiliations
Meta-Analysis

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis

Lesley A Tarasoff et al. Am J Obstet Gynecol. 2020 Jan.

Abstract

Background: Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications.

Objective: A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications.

Study design: Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies.

Results: The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation.

Conclusion: Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.

Keywords: cesarean delivery; developmental disabilities; disabled persons; gestational diabetes; meta-analysis; postpartum period; pregnancy; pregnancy complications; pregnancy-induced hypertension; systematic review.

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Conflict of interest statement

Conflict of Interest Statement: The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA diagram for study selection
Figure 2.
Figure 2.
Unadjusted association between maternal disability status and gestational diabetes.
Figure 3.
Figure 3.
Unadjusted association between maternal disability status and hypertensive disorders of pregnancy.
Figure 4.
Figure 4.
Unadjusted association between maternal disability status and cesarean section.
Figure 5.
Figure 5.
Adjusted association between maternal disability status and cesarean section.
See this image and copyright information in PMC

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