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，自闭症谱系障碍（ASD）的妇女经历了独特的挑战 围绕生殖和性健康。加剧这些问题，积极的妇女面临医疗保健 获得妇女卫生服务的差异。在Kaiser Permanente北加州（KPNC），一个大的 综合医疗保健系统，我们发现患有ASD的妇女利用妇科护理和宫颈癌 筛查几乎是ADHD或典型神经发育女性的一半。 AIM 1考试 因素，包括社会人口统计学特征，医学和精神疾病以及其他类型的因素 医疗保健利用可能有助于加速妇女在不同类型的妇科护理中的利用。目标2 将检查ASD女性怀孕的流行病学以及令人印象深刻的女性是否也经历 产科护理的差距，这一领域在很大程度上被理解。我们将在没有和没有的情况下品尝女性 使用病例对照研究设计的自闭症。 KPNC自闭症注册表中目前有2600名成年妇女 其中有350名怀孕者列举。随着浪潮的潮流 被诊断出患有ASD的儿童成年。我们将研究妇产科/妇科的差异 一月份的利用，包括频率和访问，程序和处方的计数 2016年至2020年12月。我们将检查怀孕历史，延伸到1995年，即KPNC 建立了门诊数据库。使用多元逻辑回归，我们将检查是否因素 例如种族/种族，ASD诊断年龄以及心理和身体健康状况与 与对照组相比，ASD女性妇科护理的利用。我们还将描述 怀孕和产科护理利用的流行病学，包括妊娠的超声检查和筛查 与对照组相比，侵略性女性中的糖尿病。鉴于Covid-19对医疗保健的影响，我们将 进行专注于2020年护理提供的分析，以探索向远程医疗的转变可能是如何的 影响有和没有ASD的妇女之间的OB/GYN护理分布。研究结果将告知 制定改善提供者知识，护理实践和有效妇产科的策略 ASD成年妇女的医疗保健提供。