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

了解患有自闭症谱系障碍 (ASD) 的女性的生殖保健障碍

• 批准号: 10366066
• 负责人: Jennifer Lisa Ames
• 金额: $ 8万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10366066
• 关键词: Address; Adult; Advocacy; Age; Anxiety; Area; Attention deficit hyperactivity disorder; Back; Behavior; Behavioral; Biological; COVID-19; COVID-19 impact; California; Caring; Case-Control Studies; Cervical Cancer Screening; Characteristics; Child; Complications of Diabetes Mellitus; Computerized Medical Record; Data; Databases; Development; Developmental Disabilities; Diagnosis; Discipline of obstetrics; Eating Disorders; Emotions; Epidemiology; Epilepsy; Ethnic Origin; Etiology; Face; Feeling; Frequencies; Future; Gestational Diabetes; Gynecologic; Gynecology; Health; Health Services; Health Status; Healthcare; Hypersensitivity; Improve Access; Incidence; Integrated Delivery of Health Care; Integrated Health Care Systems; Intellectual functioning disability; Investigation; Knowledge; Literature; Logistic Regressions; Longevity; Medical; Menstruation; Mental Depression; Mental Health; Mothers; Outcome; Outpatients; Pain; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Histories; Premature Birth; Premature Labor; Prenatal care; Prevalence; Preventive healthcare; Procedures; Provider; Race; Registries; Regulation; Reproductive Health; Research; Research Design; Risk; Sampling; Sensory; Services; Sex Behavior; Sexual Health; Sexual abuse; Social Change; Surveys; Sweden; Symptoms; System; Telemedicine; United States; Visit; Woman; Women' s Health Services; autism spectrum disorder; autistic; care delivery; delivery complications; epidemiology study; experience; gender dysphoria; health care delivery; health care disparity; health care service utilization; health disparity; high risk; improved; individuals with autism spectrum disorder; male; neurodevelopment; obstetric care; physical conditioning; public health relevance; screening; screening guidelines; sex; sexually active; social; social communication; sociodemographics; ultrasound

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.

抽象的 早期证据表明，患有自闭症谱系障碍 (ASD) 的女性面临着独特的挑战 围绕生殖和性健康。加剧这些问题的是，自闭症女性面临医疗保健 获得妇女保健服务方面的差异。在北加州凯撒医疗机构 (KPNC)，一个大型 综合医疗保健系统，我们发现患有自闭症谱系障碍的女性利用妇科护理和宫颈癌 患有多动症或典型神经发育的女性的筛查率几乎是其一半。目标 1 检查哪些 因素，包括社会人口特征、医疗和精神状况以及其他类型 医疗保健的利用可能会导致自闭症女性未充分利用不同类型的妇科护理。目标2 将检查患有自闭症谱系障碍的女性怀孕的流行病学以及自闭症女性是否也会经历 产科护理方面的差距，这一领域在很大程度上尚未得到充分研究。我们将对有或没有的女性进行抽样调查 使用病例对照研究设计的自闭症。目前 KPNC 自闭症登记处有 2600 名成年女性 其中有 350 例怀孕。随着浪潮的到来，这个人口正在急剧增长 被诊断患有 ASD 的儿童已成年。我们将检查妇产科的差异 一月份的使用情况，包括就诊、手术和处方的频率和次数 2016年至2020年12月。我们将检查追溯到1995年的怀孕史，即KPNC的那一年 建立了门诊数据库。使用多元逻辑回归，我们将检查因素是否 例如种族/族裔、自闭症谱系障碍 (ASD) 诊断时的年龄以及精神和身体健康状况与 与对照组相比，患有 ASD 的女性对妇科护理的利用情况。我们还将描述 妊娠流行病学和产科护理利用，包括超声检查和妊娠筛查 与对照组相比，自闭症女性患有糖尿病。鉴于 COVID-19 对医疗保健的影响，我们将 对 2020 年的护理服务进行分析，探讨向远程医疗的转变可能会发生什么 影响患有自闭症谱系障碍 (ASD) 和非自闭症谱系障碍 (ASD) 的女性之间的妇产科护理差异。研究结果将告知 制定战略以提高提供者的知识、护理实践和有效的妇产科 为患有 ASD 的成年女性提供医疗保健。