Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis

Abstract

Context: Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring.

Objective: We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes.

Data sources: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020.

Study selection: Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English.

Data extraction: We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses.

Results: Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes.

Limitations: Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation.

Conclusions: In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.

FIGURE 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for study selection. ^a “Ineligible exposure definition” included studies examining chronic conditions without evidence of functional limitations, studies that examined individual disabilities (eg, lupus), studies in which disability was not identified before pregnancy, and studies in which disability was not defined. IDD, intellectual and/or developmental disability.

FIGURE 2

Unadjusted association between maternal disability status and preterm birth. The figure displays the unadjusted ORs and 95% CIs for the association between (A) sensory disabilities and (B) intellectual and/or developmental disabilities and preterm birth, along with the weight of each study. Measures of heterogeneity (Q and I² statistics) and prediction intervals for analyses with at least 5 studies are also presented. ^a Ref .

FIGURE 3

Adjusted association between maternal disability status and preterm birth. The figure displays the adjusted odds ratios (aORs) and 95% CIs for the association between (A) sensory disabilities and (B) intellectual and/or developmental disabilities and preterm birth, along with the weight of each study. Measures of heterogeneity (Q and I² statistics) and prediction intervals for analyses with at least 5 studies are also presented. ^a Ref .

FIGURE 4

Unadjusted association between maternal disability status and low birth weight. The figure displays the unadjusted ORs and 95% CIs for the association between (A) any disability, (B) physical disabilities, (C) sensory disabilities, and (D) intellectual and/or developmental disabilities and low birth weight, along with the weight of each study. Measures of heterogeneity (Q and I² statistics) and prediction intervals for analyses with at least 5 studies are also presented. ^a Ref . ^b Ref .

FIGURE 5

Adjusted association between maternal disability status and low birth weight. The figure displays the adjusted odds ratios (aORs) and 95% CIs for the association between (A) sensory disabilities and (B) intellectual and/or developmental disabilities and low birth weight, along with the weight of each study. Measures of heterogeneity (Q and I² statistics) and prediction intervals for analyses with at least 5 studies are also presented.