Preconception health risks by presence and type of disability among U.S. women.

BACKGROUND: Poor preconception health may contribute to adverse perinatal outcomes among women with disabilities. While prior research has found higher prevalence of preconception health risks among women with versus without disabilities, existing U.S. studies have not assessed how preconception health risks may differ by disability type. Understanding such differences is relevant for informing and targeting efforts to improve health opportunities and optimize pregnancy outcomes. OBJECTIVE: This cross-sectional study examined preconception health in relation to disability type among reproductive-age women in the United States. METHODS: We analyzed 2016-2019 data from the Behavioral Risk Factor Surveillance System to estimate the prevalence of 19 preconception health risk among non-pregnant women 18-44 years of age. We used modified Poisson regression to compare women with different types of disability to non-disabled women. Disability categories included: 1) hearing difficulty only; 2) vision difficulty only; 3) physical/mobility difficulty only; 4) cognitive difficulty only; 5) multiple or complex disabilities (including limitations in self-care or independent living activities). Multivariable analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS: Women with each disability type experienced a higher prevalence of indicators associated with poor preconception health compared to women with no disabilities. The number and extent of health risks varied substantially by disability type. Women with cognitive disabilities and women with multiple or complex disabilities experienced the greatest risk. CONCLUSIONS: Addressing the specific preconception health risks experienced by women with different types of disabilities may help reduce adverse perinatal outcomes for disabled women and their infants.

Pre-Pregnancy Health Risks by Presence and Extent of Disability, 2019-2020.

INTRODUCTION: Prior studies have shown that, compared to non-disabled women, women with disabilities have a higher burden of preconception mental and physical health risks that are associated with adverse pregnancy outcomes. This cross-sectional study assesses how the extent of disability relates to pre-pregnancy health risks. METHODS: This study used 2019-2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n=37,006). In 2023, associations between extent of disability (none [reference group], some difficulty, or a lot of difficulty) and preconception health risks were examined using multivariable Poisson regression with robust standard errors to calculate adjusted prevalence ratios (aPRs) and 95% CIs while controlling for sociodemographic characteristics. Preconception health risks included smoking, heavy drinking, high blood pressure, diabetes, no multivitamin use, and experiencing physical abuse, depression, or obesity. Individual risks were analyzed, as well as the total number of risks experienced. RESULTS: Of respondents, 33.6% had some difficulty and 6.3% had a lot of difficulty. The likelihood of experiencing preconception health risks increased with extent of disability. Compared to respondents with no difficulty, those with some or a lot of difficulty had a higher prevalence of experiencing 1-2 health risks (aPR=1.13, 95% CI 1.09, 1.18; aPR=1.20; 95% CI 1.53, 2.25) and 3+ health risks (aPR=1.86, 95% CI 1.53, 2.25; aPR=2.42, 95% CI 1.98, 2.97), respectively. CONCLUSIONS: Disabled women, especially those with more difficulty, are vulnerable to preconception health risks that could potentially be mitigated before conception. These findings highlight the need for enhanced efforts to support preconception health of disabled women.

Injury-related emergency department use among people with intellectual and developmental disabilities insured by Medicaid from 2010 to 2016.

OBJECTIVES: Data on non-fatal injuries and visits to the emergency department (ED) for injuries are not readily available. The objective of this paper is to describe injury-related ED visits for people with intellectual and developmental disabilities who are covered by the Medicaid insurance programme. METHODS: We aggregated 2010-2016 Medicaid claims data from eight states. Using these data, we identified individuals with intellectual and developmental disabilities and then determined an all-cause ED visit rate, ED visit due to injury rate and admission from ED due to injury rate. Data were stratified by sex and age group. Results were compared with national rates. RESULTS: Medicaid members with intellectual and developmental disabilities visited EDs at approximately 1.8 times the rate of the general population. The ED visit rate due to injury was approximately 1.5 times that observed in the population overall. When ED visits due to injury data were stratified by age and sex, the largest discrepancy was observed in women ages 45-64, who visited EDs due to injury at a rate 2.1 times that of women of the same age in the general population. The admission rate from ED due to injury increased over the study period most notably in the older age groups. CONCLUSIONS: While rates and patterns of ED utilisation among Medicaid members with intellectual and developmental disabilities vary by age and gender, our findings suggest this group visits the ED due to injury at rates well above the general population.

Healthy and Respectful Relationship Education: Differences by Disability Status and Associations With Sexual Abuse.

BACKGROUND: Education about healthy and respectful relationships (HRR) is a key component of comprehensive sexual health curricula and is supposed to be universally provided in Oregon. This study: (1) assesses the extent to which high school students with disabilities received HRR education, and (2) examines associations between HRR education and experiences of sexual abuse. METHODS: Using data from the 2019 Oregon Healthy Teens survey, we conducted multivariable Poisson regression to compare 11th grade students with and without disabilities on self-reported receipt of school based HRR instruction (N = 10,992), and to measure associations between HRR education and sexual abuse experiences among teens with (N = 3736) and without (N = 7256) disabilities. RESULTS: Students with disabilities were 41% more likely than students without disabilities to say they had never been taught in school about HRR (adjusted prevalence ratio 1.41, 95% confidence interval: 1.25-156). Experiences of sexual abuse victimization were more common for all students who did not receive HRR education (34.1% vs 21.6% among students with disabilities; 16.2% vs 7.5% among students without disabilities). CONCLUSIONS: Students with disabilities are less likely to have received school-based HRR education than their peers without disabilities. Providing inclusive HRR education may help reduce risk of sexual abuse and is essential for addressing health disparities affecting youth with disabilities.

Perinatal Health Risks And Outcomes Among US Women With Self-Reported Disability, 2011-19.

Women with disabilities experience elevated risk for adverse pregnancy outcomes. Most studies have inferred disabilities from diagnosis codes, likely undercounting disabilities. We analyzed data, including self-reported disability status, from the National Survey of Family Growth for the period 2011-19. We compared respondents with and without disabilities on these characteristics: smoking during pregnancy, delayed prenatal care, preterm birth, and low birthweight. A total of 19.5 percent of respondents who had given birth reported a disability, which is a much higher prevalence than estimates reported in US studies using diagnosis codes. Respondents with disabilities were twice as likely as those without disabilities to have smoked during pregnancy (19.0 percent versus 8.9 percent). They also had 24 percent and 29 percent higher risk for preterm birth and low birthweight, respectively. Our findings suggest that studies using diagnosis codes may represent only a small proportion of pregnancies among people with disabilities. Measurement and analysis of self-reported disability would facilitate better understanding of the full extent of disability-related disparities, per the Affordable Care Act.

Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities.

BACKGROUND: Little is known about severe maternal morbidity (SMM) among women with disabilities. OBJECTIVE: We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities. METHODS: We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23-42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate-adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes. RESULTS: Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities). CONCLUSION: As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.

Prevalence and patterns of youth responses to standard disability survey questions.

BACKGROUND: In 2011, the US Department of Health and Human Services adopted a minimum set of six standardized questions about disability to be used in population-based health surveys. These questions have been validated for self- and proxy-report use by adults, but how they perform for adolescents is unknown. OBJECTIVE: To describe how 8th grade students, 11th grade students, and young adults aged 18-24 years in Oregon answer these questions. METHODS: Cross-sectional study design. Data for the 8th and 11th grade students were derived from the Oregon Health Teens survey (OHT; 2017 and 2019); data for young adults aged 18-24 were from the Behavioral Risk Factor Surveillance System (BRFSS; 2017 and 2018). Unweighted counts, weighted proportions and 95% confidence intervals were calculated for socio-demographic characteristics, the six disability questions, and overall disability status (yes/no) among 8th graders (n = 14,396), 11th graders (n = 23,517), and young adults (n = 1112). RESULTS: Responses for 8th and 11th grade students were materially consistent for all six questions. Young adults were markedly less likely to report cognitive disability compared to 8th and 11th graders (17.2% vs. 24.9% and 27.0%, respectively) and somewhat less likely to report an independent living disability (6.5% vs. 8.6% and 9.8%, respectively). CONCLUSION: Differences in cognitive disabilities between adolescents and young adults may either be due to differences in underlying impairment or the result of youth interpreting this question differently than adults. Validation of the standardized disability identifiers for self-report in adolescents is needed.

"It Would Have Been Nice to Have a Choice": Barriers to Contraceptive Decision-making among Women with Disabilities.

INTRODUCTION: Engaging in contraceptive decisions is an important part of reproductive health for women and other people with the capacity for pregnancy. However, not all individuals capable of pregnancy have equal access to information and/or opportunities to make fully informed decisions. The goal of this study was to understand barriers women with disabilities experience around contraceptive decision-making and whether these differ based on type of disability. METHODS: We conducted focus groups with 17 reproductive age adult women (aged 18-45 years). Focus groups were homogenous with regard to disability type and consisted of one group for each of the following disability categories: 1) physical disability, 2) intellectual and developmental disabilities, 3) blind or low vision, and 4) Deaf users of American Sign Language. Data were collected in the Portland, Oregon, metropolitan area during 2016-2017. We analyzed focus group transcripts using content analysis. RESULTS: Barriers to informed contraceptive decision-making emerged in five main thematic areas: 1) lack of information in accessible formats, 2) incomplete information about contraceptive side effects, 3) limited clinician knowledge and relevant research specific to the care of women with disabilities, 4) taboos around discussing sexual activity, and 5) limited opportunities for shared contraceptive decision-making. CONCLUSIONS: Women with disabilities faced numerous barriers to contraceptive decision-making. Although the barriers differed somewhat by disability type, many barriers were consistent across groups, suggesting commonalities associated with the experience of disability in the context of contraceptive decision-making. Increased attention to the reproductive health needs of people with disabilities is important for improving health care equity and quality.

Assessing Intersectional Disparities in Cervical Cancer Screening by Disability Status, Race, and Ethnicity.

Introduction: Separate bodies of research have studied disparities by disability status and by race or ethnicity in receipt of cervical cancer screening. Much less is known about how these disparities intersect. The purpose of this study was to evaluate disparities in compliance with the U.S. Preventive Services Task Force guidelines for Pap testing in age-eligible women at the intersection of disability and race or ethnicity. Methods: We conducted cross-sectional analyses of the Medical Expenditure Panel Survey Household Component deidentified public data files pooled for years 2007-2016, using a modified Poisson regression analysis to compute prevalence ratios for being up to date with Pap testing by disability status and race or ethnicity. We also calculated predicted marginal proportions adjusting for demographic and socioeconomic covariates. Results: The analytic sample included 68,507 women with nonmissing covariates; 15.6% had a disability. Overall, the proportion current with Pap testing was significantly lower among women with disabilities than among those without disabilities (82.1% vs 88.6%, p<0.0001). Furthermore, within each racial and ethnic group, women with disabilities were less likely than those without disabilities to be current with Pap testing. In adjusted analyses, prevalence ratios for White women with disabilities (adjusted prevalence ratio=0.94; 95% CI=0.92, 0.96) and other race women with and without disabilities (adjusted prevalence ratio=0.91; 95% CI=0.86, 0.95 and adjusted prevalence ratio=0.91; 95% CI=0.89, 0.95, respectively) were significantly below those for the reference group of White women without disabilities. Hispanic women with disabilities did not differ significantly from White women without disabilities, and Black women with disabilities had significantly higher adjusted prevalence ratios than White women without disabilities (adjusted prevalence ratio=1.07; 95% CI=1.05, 1.09). When taking covariates into account, the proportion of Black women with disabilities current with screening was only slightly lower than the estimated proportion for Black women without disabilities (92% vs 93%). The gap in screening between White women with and without disabilities narrowed somewhat (from 9 percentage points to 4 percentage points) but remained significant. Conclusions: Our results extend previous research focused separately on disability or race and ethnicity. Women with disabilities in all racial and ethnic groups fell short of Healthy People 2020 goals for cervical cancer screening.

Contraceptive Use Among Adolescents With and Without Disabilities.

PURPOSE: The aim of this study is to assess contraceptive use at last intercourse among adolescent girls with and without disabilities. METHODS: Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. Among respondents at risk for unplanned pregnancy (n = 3,702), we estimated the prevalence of contraceptive method used at last intercourse-including intrauterine device, implant, Depo-Provera, oral contraceptive pills, patch, ring, condoms, withdrawal, and emergency contraception-by disability status. We used multivariable Poisson regression to measure the association between disability status and use of any contraceptive. RESULTS: Girls with disabilities were more likely to report having had intercourse compared to girls without disabilities (49.2% vs. 37.4%). Girls with disabilities were less likely to use oral contraceptive pills (32.8% vs. 36.6%) or condoms (51.9% vs. 59.7%) compared to their non-disabled peers. After adjusting for demographic factors, 92.3% of girls with disabilities reported using any contraceptive method compared to 94.7% of girls without a disability (adjusted prevalence difference -2.6%, 95% CI -.26%, -4.9%; adjusted prevalence ratio .97, 95% CI .95-1.00, p = .03). CONCLUSIONS: We observed high levels of contraceptive use among Oregon high school girls. Still, girls with disabilities were slightly less likely to report contraceptive use compared to their non-disabled peers. Given the high proportion of teens with disabilities who are sexually active, the magnitude of the difference in contraceptive use could be of concern on a national scale and further research is warranted.

Time trends in emergency department use among adults with intellectual and developmental disabilities.

BACKGROUND: Emergency Department (ED) visits are common among adults with intellectual and developmental disabilities (IDD). However, little is known about how ED use has varied over time in this population, or how it has been affected by recent Medicaid policy changes. OBJECTIVE: To examine temporal trends in ED use among adult Medicaid members with IDD in eight states that ranged in the extent to which they had implemented state-level Medicaid policy changes that might affect ED use. METHODS: We conducted repeated cross-sectional analyses of 2010-2016 Medicaid claims data. Quarterly analyses included adults ages 18-64 years with IDD (identified by diagnosis codes) who were continuously enrolled in Medicaid for the past 12 months. We assessed change in number of ED visits per 1000 member months from 2010 to 2016 overall and interacted with state level policy changes such as Medicaid expansion. RESULTS: States with no Medicaid expansion experienced an increase in ED visits (linear trend coefficient: 1.13, p < 0.01), while states operating expansion via waiver had a much smaller (non-significant) increase, and states with ACA-governed expansion had a decrease in ED visits (linear trend coefficient: 1.17, p < 0.01). Other policy changes had limited or no association with ED visits. CONCLUSIONS: Medicaid expansion was associated with modest reduction or limited increase in ED visits compared to no expansion. We found no consistent decrease in ED visits in association with other Medicaid policy changes.

Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care.

OBJECTIVE: To conduct an initial exploration of the experiences of women with different types of disability when they attempt to obtain contraceptive care. DESIGN: Multiple-category focus group design. SETTING: Multiple community sites. PARTICIPANTS: Seventeen women with disabilities of reproductive age. METHODS: We purposively sampled women with different types of disability and conducted four focus groups organized by disability type: physical disability, intellectual and developmental disability, blind or low vision, and deaf or hard of hearing. We used a semistructured focus group guide to elicit participants' positive and negative experiences with contraceptive care. We analyzed focus group transcripts using content analysis. RESULTS: Participants identified challenges to obtaining high-quality contraceptive care in three main thematic areas: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Participants with physical disabilities encountered inaccessible clinic rooms and examination tables, and those with sensory disabilities or intellectual and developmental disability described inaccessible clinic forms and information. Participants from multiple disability groups described negative attitudes of health care providers and health insurance limitations. CONCLUSION: As described by our participants, the processes and infrastructure of contraceptive care were based on an assumption of an able-bodied norm. Reliance on such a norm, for example, offering a paper pamphlet to a blind woman, is not helpful and can be harmful to women with disabilities. Increased attention to the reproductive health care needs of women with disabilities is important for improving health care equity and quality.

Sexual Health Experiences Among High School Students With Disabilities.

PURPOSE: The purpose of this study was to investigate the sexual experiences of adolescents with and without disabilities. METHODS: Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. We compared teens with and without disabilities on whether or not they had ever had sexual intercourse (N = 20,812). Among those who had ever had intercourse (N = 8,311), we used multivariable Poisson regression to measure the association between disability status and the prevalence of five sexual experiences. RESULTS: After adjusting for sociodemographic characteristics, the prevalence of ever having had intercourse was 25% higher among teens with disabilities than among those without (adjusted prevalence ratio [aPR] 1.25, 95% confidence interval [CI]: 1.20-1.30). Among students who had had intercourse, the prevalence of having had intercourse before the age of 15 years (aPR 1.25, 95% CI: 1.14-1.47), having ≥ 2 lifetime sexual partners (aPR 1.13, 95% CI 1.07-1.19), having ≥ 2 sexual partners in the previous three months (aPR 1.23, 95% CI: 1.00-1.52), having used alcohol and/or drugs at the last intercourse (aPR 1.28, 95% CI: 1.10-1.48), and having condomless sex at the last intercourse (aPR 1.17, 95% CI: 1.08-1.27) was higher among students with disabilities than among students without disabilities. After accounting for sexual abuse, each of these associations was attenuated and most were no longer significant. CONCLUSIONS: Youth with disabilities are sexually active. Findings highlight the need for increased attention to sexual abuse prevention, sexual health promotion, and risk reduction efforts for this population.

The Medicaid expansion did not crowd out access for medicaid recipients with disabilities in Oregon.

BACKGROUND: The Affordable Care Act (ACA) substantially increased the number of Medicaid enrollees, which could have reduced access to health care services for those already on Medicaid before the expansion. OBJECTIVE: To examine the association of the ACA expansion on health care access and utilization for adults ages 18-64 years who have qualified for Supplemental Security Income (SSI) in Oregon. METHODS: We used Oregon Medicaid claims and enrollment data from 2012 to 2015 and information from the American Community Survey and the Local Area Unemployment Statistics. Multivariate regressions compared changes in health care access and utilization before and after the expansion among Medicaid recipients who qualified for SSI across counties in Oregon with higher and lower Medicaid enrollment increases due to the expansion. Health care access and utilization outcome measures included: primary care visits, non-behavioral health outpatient visits, behavioral health outpatient visits, emergency department (ED) visits and potentially avoidable ED visits. RESULTS: The Medicaid expansion led to an uneven increase in Medicaid enrollment across Oregon's counties (mean increase from the first quarter of 2012 to the third quarter of 2015: 12.4% points; range: 7.3 to 18.6% points). Access and utilization outcomes for SSI Medicaid recipients were mostly unaffected by differential enrollment increases. ED visits increased more in counties with a larger Medicaid enrollment increase (estimate: 1.8, p < 0.05), but adjusting for pre-expansion trends eliminated this association. CONCLUSIONS: We did not find evidence that an increase in Medicaid enrollment due to the ACA negatively impacted access and utilization for adult Medicaid recipients on SSI, who were eligible for Medicaid prior to expansion.

Preconception Health Risks Among U.S. Women: Disparities at the Intersection of Disability and Race or Ethnicity.

INTRODUCTION: Prior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic group. The purpose of this study was to assess preconception health at the intersection of disability and race or ethnicity. METHODS: We analyzed data from the 2016 Behavioral Risk Factor Surveillance System to estimate the prevalence of health behaviors, health status indicators, and preventive healthcare receipt among nonpregnant women 18-44 years of age. We used modified Poisson regression to compare non-Hispanic White women with disabilities and women with and without disabilities in three other race/ethnicity groups (non-Hispanic Black, Hispanic, other race) to a reference group of non-Hispanic White women without disabilities. Disability status was defined based on affirmative response to at least one of six questions about difficulty with seeing, hearing, mobility, cognition, personal care, or independent living tasks. Multivariate analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS: In every racial and ethnic group, women with disabilities had a significantly higher prevalence of most preconception health risks than their counterparts without disabilities. The disparity in obesity for Black women with disabilities was additive, with the adjusted prevalence ratio (PR, 1.77; 95% confidence interval [CI], 1.57-2.00) equal to the sum of the prevalence ratios for disability alone (PR, 1.29; 95% CI, 1.19-1.41) and Black race alone (PR, 1.47; 95% CI, 1.36-1.58). CONCLUSIONS: Women at the intersection of disability and minoritized race or ethnicity may be at especially high risk of adverse outcomes. Targeted efforts are needed to improve the health of women of reproductive age in these doubly marginalized populations.

Disparities in E-Cigarette and Tobacco Use Among Adolescents With Disabilities.

INTRODUCTION: In 2019, nearly 30% of US high-school students reported current (past 30 day) e-cigarette use. Adolescents with disabilities are consistently more likely to smoke cigarettes compared with their nondisabled peers, yet little is known about their use of other forms of tobacco, including e-cigarettes. We compared the prevalence of tobacco use (e-cigarettes, cigarettes, little cigars, large cigars, hookahs, and smokeless tobacco) among high school students with at least 1 disability to those without disability. METHODS: Data were from the 2015 and 2017 Oregon Healthy Teens survey, a statewide representative sample of 11th-grade students. We estimated the prevalence of current (past 30 day) tobacco use by product type and disability status (yes or no). We used multivariable Poisson regression to estimate prevalence ratios measuring the association between disability status and current tobacco use, by product: 1) combustible products only, 2) e-cigarettes only, and 3) dual use of combustibles and e-cigarettes. RESULTS: Students with disabilities were more likely to use a variety of tobacco products compared with their nondisabled peers, including cigarettes (12.3% vs 5.4%), little cigars (7.0% vs 5.4%), hookahs (6.2% vs 3.8%), and e-cigarettes (18.3% vs 12.3%). In adjusted models, students with a disability were more likely to report using combustibles only (adjusted prevalence ratio [aPR], 1.55; 95% CI, 1.31-1.84), e-cigarettes only (aPR, 1.36; 95% CI, 1.16-1.59), or dual use (aPR, 1.52; 95% CI, 1.29-1.80) compared with nondisabled students. CONCLUSION: Effective tobacco control programs should target populations with the greatest burden of tobacco use. Results suggest that tobacco prevention and reduction efforts should explicitly include adolescents with disabilities and employ accommodations that support their participation in program activities.

Prolonged postpartum length of hospital stay among women with disabilities.

BACKGROUND: Prior studies have found higher proportions of cesarean deliveries and longer postpartum hospital stays among women with disabilities compared to women without disabilities. However, no research has assessed how length of stay may differ for women with different types of disability while also considering mode of delivery. OBJECTIVE: To examine the association of disability status and disability type with length of stay, taking into account disability-related differences in mode of delivery. METHODS: We conducted a retrospective cohort study using linked maternal and infant hospital discharge and vital records data for all births in California between 2000 and 2012 (n = 6,745,201). We used multivariable regression analyses to assess association of disability status and type with prolonged length of stay (>2 days for vaginal delivery or >4 days for cesarean) while controlling for covariates. RESULTS: Women with disabilities had significantly elevated adjusted odds of prolonged length of stay compared to women without disabilities (aOR = 1.40, 95% CI = 1.32-1.49). Adjusted odds were highest for women with vision disabilities (aOR = 1.67, 95% CI = 1.46-1.90), followed by women with IDD (aOR = 1.53, 95% CI = 1.30-1.80), and women with physical disabilities (aOR = 1.41, 95% CI = 1.32-1.50). Women with hearing disability had the lowest adjusted odds of prolonged length of stay (aOR = 1.17, 95% CI = 1.03-1.33). CONCLUSIONS: Prolonged length of stay did not appear to be due solely to the higher proportion of cesarean deliveries in this population. Further research is needed to better understand the reasons for prolonged length of stay among women with disabilities and develop strategies to assist women with disabilities in preparing for and recovering from childbirth.

Pregnancy Intendedness by Maternal Disability Status and Type in the United States.

CONTEXT: Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities. METHODS: Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates. RESULTS: A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9). CONCLUSIONS: Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.

Medical indications for primary cesarean delivery in women with and without disabilities.

Background: Prior research has found that women with disabilities are more likely to deliver by cesarean than are women without disabilities. It is not clear whether all of the cesarean deliveries among women with disabilities are medically necessary.Objectives: To examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries.Study design: Retrospective cohort study of all nulliparous births in California between 2000 and 2012. We classified births as to whether or not women underwent a trial of labor and determined if medical indications for cesarean delivery were present. Multivariable logistic regression models examined the association of disability with trial of labor and indications for cesarean delivery.Results: Women with disabilities had lower odds of having a labored delivery, compared to women without disabilities (adjusted odds ratio (aOR) = 0.45, 95% confidence interval (CI) 0.41-0.49). In the sample of women who labored (90.5% of total), women with disabilities were more likely to have a medical indication for cesarean delivery (aOR = 1.15, 95% CI 1.10-1.21) and were more likely to have a cesarean delivery (aOR = 1.46, 95% CI = 1.38-1.54). In the subsample of unlabored cesarean deliveries, women with disabilities were less likely to have documented medical indications for cesarean delivery (aOR = 0.45, 95% CI = 0.41-0.50).Conclusions: Women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.

Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States.

Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.