Understanding Barriers to Reproductive Health Care among Women with Autism Spectrum Disorder (ASD)

摘要 早期证据表明，患有自闭症谱系障碍(ASD)的女性经历了独特的挑战 围绕生殖健康和性健康。使这些问题雪上加霜的是，自闭症女性面临医疗保健 在获得妇女保健服务方面的差距。在凯撒永久北加州(KPNC)，一家大型 综合医疗保健系统，我们发现患有自闭症的女性利用妇科护理和宫颈癌 筛查的比率几乎是患有ADHD或典型神经发育的女性的一半。目标1检查哪一个 因素，包括社会人口统计特征、医疗和精神状况以及其他类型的 医疗保健利用可能导致自闭症妇女未充分利用不同类型的妇科护理。目标2 将检查患有自闭症的妇女的怀孕流行病学，以及自闭症妇女是否也经历了 产科保健方面的差距，这是一个在很大程度上没有得到充分研究的领域。我们将对有无症状的女性进行抽样 使用病例对照研究设计的自闭症。目前，KPNC自闭症登记处中有2600名成年女性 其中有350例怀孕。这一人口正在戏剧性地增长，因为 被诊断为自闭症的儿童将步入成年。我们将研究产科/妇科的差异。 1月期间的使用率，包括就诊次数和次数、程序和处方 2016年至2020年12月。我们将检查1995年以来的妊娠史，也就是KPNC的 建立门诊数据库。使用多元Logistic回归，我们将检验是否有因素 例如种族/民族、被诊断为ASD年龄以及精神和身体健康状况与 自闭症妇女的妇科保健利用情况与对照组的比较。我们还将描述 妊娠流行病学和产科护理利用，包括超声波和孕期筛查 糖尿病，在自闭症女性中与对照组相比。考虑到新冠肺炎对医疗保健的影响，我们将 对2020年的医疗服务进行重点分析，以探索向远程医疗的转变可能是如何 影响患有自闭症和不患有自闭症妇女之间的妇产科护理差异。研究结果将告知 制定战略以改善提供者的知识、护理实践和有效的产科/妇科 为患有自闭症的成年女性提供保健服务。

ABSTRACT Early evidence suggests that women with autism spectrum disorder (ASD) experience unique challenges around reproductive and sexual health. Exacerbating these problems, autistic women face health care disparities in accessing women’s health services. At Kaiser Permanente Northern California (KPNC), a large integrated healthcare system, we found that women with ASD utilize gynecological care and cervical cancer screenings at nearly half the rate of women with ADHD or typical neurodevelopment. Aim 1 examines which factors, including sociodemographic characteristics, medical and psychiatric conditions, and other types of healthcare utilization may contribute to autistic women underutilizing different types of gynecologic care. Aim 2 will examine the epidemiology of pregnancy in women with ASD and whether autistic women also experience gaps in obstetric care, an area that has been largely understudied. We will sample women with and without autism using a case-control study design. There are currently 2600 adult women in the KPNC autism registry with 350 pregnancies enumerated among them. This population is growing dramatically as the wave of children diagnosed with ASD reaches adulthood. We will examine differences in obstetrics/gynecology utilization, including frequency and counts of visits, procedures, and prescriptions, in the period of January 2016 to December 2020. We will examine pregnancy history extending back to 1995, the year KPNC’s outpatient databases were established. Using multivariate logistic regression, we will examine whether factors such as race/ethnicity, age at ASD diagnosis, and mental and physical health status are associated with utilization of gynecologic care among women with ASD compared with controls. We will also describe the epidemiology of pregnancy and obstetric care utilization, including ultrasounds and screenings for gestational diabetes, among autistic women compared to controls. Given the impact of COVID-19 on health care, we will conduct an analysis focused on care delivery in 2020 to explore how the shift to telemedicine may have be impacting OB/GYN care disparities between women with and without ASD. Study findings will inform the development of strategies to improve provider knowledge, care practices, and effective obstetrics/gynecology health care delivery for adult women with ASD.