Perinatal Health of Women with Intellectual and Developmental Disabilities and Comorbid Mental Illness
Perinatal Health of Women with Intellectual and Developmental Disabilities and Comorbid Mental Illness
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DOI：
10.1177/0706743716649188
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发表时间：
2016-11-01
影响因子：
4
通讯作者：
Vigod, Simone
中科院分区：
文献类型：
--
作者：
Brown, Hilary K.;Cobigo, Virginie;Vigod, Simone
目的：智力和发育障碍(IDD)妇女围产期不良结局发生率高。然而，患有IDD和精神疾病(双重诊断)的妇女的围产期健康状况在很大程度上是未知的。我们的目标是1)描述患有双重诊断的妇女的社会和健康特征，以及2)比较她们与仅患有IDD的妇女的孕产妇和新生儿不良结局的风险。方法：我们进行了一项基于人群的研究，使用加拿大安大略省的卫生和社会服务管理数据来确定患有双重诊断的妇女(n=2080)和仅患有IDD的妇女(n=1852；2002-2012)的单胎产科分娩情况。主要的母体结局是妊娠期糖尿病、妊娠期高血压、先兆子痫/子痫和静脉血栓栓塞症。新生儿的主要结局是早产，小于胎龄，大于胎龄。我们还检查了几个次要结果。结果：双重诊断的妇女比患有IDD的妇女更有可能生活在贫穷的社区，并有孕前健康状况；然而，她们有更频繁的产前护理。与仅患有IDD的母亲所生的婴儿相比，患有双重诊断的母亲所生婴儿早产的风险(调整后的相对危险度[ARR]1.31，95%可信区间[CI]1.08至1.59)和新生儿发病率(ARR为1.35，95%可信区间为1.03至1.76)均较高。所有其他主要和次要结局均无显著意义。结论：在患有IDD的妇女中，合并精神疾病几乎不会增加不良围产期结局的风险。患有双重诊断的妇女和单独患有IDD的妇女需要加强对产妇和新生儿并发症的监测。
Objective: Women with intellectual and developmental disabilities (IDD) have high rates of adverse perinatal outcomes. However, the perinatal health of women with co-occurring IDD and mental illness (dual diagnosis) is largely unknown. Our objectives were to 1) describe a cohort of women with dual diagnosis in terms of their social and health characteristics and 2) compare their risks for adverse maternal and neonatal outcomes to those of women with IDD only.Method: We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton obstetric deliveries to women with dual diagnosis (n = 2080) and women with IDD only (n = 1852; 2002-2012). Primary maternal outcomes were gestational diabetes, gestational hypertension, preeclampsia/eclampsia, and venous thromboembolism. Primary neonatal outcomes were preterm birth, small for gestational age, and large for gestational age. We also examined several secondary outcomes.Results: Women with dual diagnosis were more likely than women with IDD only to live in poor neighborhoods and to have prepregnancy health conditions; however, they had more frequent prenatal care. Infants born to women with dual diagnosis had increased risks for preterm birth (adjusted relative risk [aRR] 1.31, 95% confidence interval [CI] 1.08 to 1.59) and neonatal morbidity (aRR 1.35, 95% CI 1.03 to 1.76) compared with infants born to women with IDD only. All other primary and secondary outcomes were nonsignificant.Conclusions: Comorbid mental illness contributes little additional risk for adverse perinatal outcomes among women with IDD. Women with dual diagnosis and women with IDD alone require increased surveillance for maternal and neonatal complications.