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

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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.