Prevalence and outcomes of pregnancy in women with disabilities

描述（由申请人提供）：估计有800万美国育龄妇女患有残疾。由于医学进步促进了残疾妇女的寿命延长和更积极的生活，这一人群对生育的兴趣增加了。然而，残疾妇女在成功和健康怀孕方面仍然面临巨大障碍。不幸的是，我们对残疾妇女怀孕的普遍性、不良后果的程度以及与这种后果有关的因素的了解仍然有限。现有的统计数据表明，残疾母亲早产和剖腹产的感染风险更大。残疾妇女所生的婴儿更有可能出生时体重不足或小于胎龄，而且围产期死亡的风险更高。然而，在人口水平上， 残疾妇女怀孕的过程和结果。此外，关于残疾妇女怀孕的比例也缺乏数据。拟议项目的目标是通过使用国家和州一级的数据来研究残疾和非残疾妇女怀孕的流行率和结果，以解决这些关键的知识差距。具体而言，我们将：1）确定与非残疾妇女相比，残疾妇女和特定类型残疾妇女的怀孕率~ 2）确定残疾妇女中不良妊娠结局的患病率和相关因素~ 3）确定残疾与不良妊娠结局的独立关联。我们将使用来自医疗支出小组调查（MEPS）的数据，以确定在参与小组调查期间怀孕的残疾妇女的特征，并估计这一人群的规模。我们将使用来自加州的MEPS和出院和出生证明数据，以产生有关残疾妇女妊娠结局的新知识，不良结局的风险因素，以及残疾在导致不良结局方面的独特作用。这项探索性研究将通过利用来自大型代表性数据源的数据来推动该领域的发展，这将使我们能够研究相对罕见的妊娠和新生儿结局，这些结果无法使用较小的样本进行充分研究。实现我们的目标将提供关于残疾妇女围产期问题的重要知识，这一人群可能特别容易受到不良后果的影响。我们的研究结果将使临床医生为残疾妇女提供更明智的孕前护理和咨询，并可能影响残疾妇女的计划生育和相关的医疗保健决策。我们的研究结果也将对加强残疾母亲及其婴儿的产前、分娩和产后护理具有重要意义。

DESCRIPTION (provided by applicant): An estimated 8 million U.S. women of childbearing age have a disability. As medical advances have facilitated longer lifespans and more active lives for women with disabilities, interest in childbearing in this population has increased. However, women with disabilities still face substantial barriers to successful and healthy pregnancies. Unfortunately, our understanding of the prevalence of pregnancy, the extent of adverse outcomes, and the factors associated with such outcomes among women with disabilities, remains limited. The statistics that are available suggest greater risk of infections preterm birth, and cesarean delivery for mothers with disabilities. Infants born to women with disabilities are more likely to be low birth weight or small for gestational age, and are at increased risk of perinatal death. However, there is little information at a population level about the course and outcomes of pregnancy in women with disabilities. Furthermore, there is a dearth of data on what proportion of women with disabilities even experience pregnancy. The objective of the proposed project is to address these key knowledge gaps by using both national and state level data to study prevalence and outcomes of pregnancy in women with and without disabilities. Specifically, we will: 1) establish the prevalence of pregnancy among women with disabilities overall, and with particular types of disabilities, compared to women without disabilities~ 2) identify the prevalence and correlates of adverse pregnancy outcomes among women with disabilities~ and 3) determine the independent association of disability with adverse pregnancy outcomes. We will use data from the Medical Expenditure Panel Survey (MEPS) to identify the characteristics of women with disabilities who were pregnant during their panel participation and estimate the size of this population. We will use both the MEPS and hospital discharge and birth certificate data from California to generate new knowledge about outcomes of pregnancy in women with disabilities, risk factors for adverse outcomes, and the unique role of disability in contributing to adverse outcomes above and beyond other risk factors. This exploratory research will move the field forward by utilizing data from large, representative data sources, which will allow us to study relatively rare pregnancy and neonatal outcomes that cannot be researched adequately using smaller samples. Achievement of our aims will provide crucial knowledge about the perinatal issues of women with disabilities, a population that is likely to be particularly vulnerable to adverse outcomes. Our findings will enable clinicians to provide more informed preconception care and counseling for women with disabilities, and may influence family-planning and associated healthcare decisions of women with disabilities. Our results will also have important implications for enhancing prenatal, delivery, and postpartum care for mothers with disabilities and their infants.