Pregnancy Outcomes in Women with Disabilities: Exploratory Research

描述（由申请人提供）：残疾妇女的生育人数有所增加，尽管很少有研究调查受影响妇女的妊娠过程和分娩结果，大多数报告基于小型单一机构的病例系列。有身体或智力残疾的妇女可能具有使她们或她们的婴儿面临更大不良后果风险的特点，因此，提高我们对她们如何获得健康结果和后代的理解非常重要。这是一个探索性项目的重新提交建议，该项目使用现有的基于人群的数据来检查身体和智力残疾妇女的妊娠结局。流行病学数据分析将使用现有的关联出生医院出院记录来识别1987-2011年华盛顿州分娩时存在身体、智力或其他残疾的妇女。将根据出院记录中的ICD代码确定近3000名残疾妇女的分娩情况。一组没有残疾的妇女将以10:1的比例随机选择，频率与分娩年份相匹配。将按残疾类型描述残疾妇女分娩的总数和比例。将衡量残疾妇女和非残疾妇女在个人和行为特征（分娩年龄、受教育程度、孕前体重、吸烟状况等）以及与获得护理和社会支持有关的因素（产前护理、健康保险、婚姻状况等）方面的差异程度。将比较有不同残疾和无不同残疾妇女亚组的妊娠情况（如先兆子痫、妊娠糖尿病）和结局（早产、剖腹产、婴儿出生体重低、胎龄小、畸形、需要再住院等）的发生情况。我们将确定并会见该地区的服务提供者和支持团体（“社区合作伙伴”），以更全面地了解最相关的问题和需要探索的变量，并讨论结果，目标是制定未来对结果、问题或子群体的有针对性的评估。

DESCRIPTION (provided by applicant): Childbearing among women with disabilities has increased, although few studies have examined pregnancy course and birth outcomes among affected women, with most reports based on small, single institution case series. Women with physical or intellectual disabilities may have characteristics placing them or their infants at increased risk of adverse outcomes, so it is important to improve our understanding of how they may achieve healthy outcomes and offspring. This is a resubmission proposal for an exploratory project using existing population-based data to examine pregnancy outcomes in women with physical and intellectual disabilities. Epidemiologic data analyses will use existing linked birth-hospital discharge records to identify women with physical, intellectual, or other disabilities wit deliveries in Washington State 1987-2011. Nearly 3000 deliveries to women with disabilities will be identified based on ICD codes in the hospital discharge record. A comparison group of women without disabilities will be randomly selected in a 10:1 ratio, frequency matched on delivery year. The number and proportion of deliveries to women with disabilities overall, and by type of disability will be described. The extent to which women with and without disabilities diffe with respect to personal and behavioral characteristics (age at delivery, education, pre-pregnancy weight, smoker status, etc.), and factors related to care access and social support (prenatal care, health insurance, marital status, etc.) will be measured. The occurrence of pregnancy conditions (e.g., preeclampsia, gestational diabetes) and outcomes (preterm delivery, c-section, infant low birth weight, small size for gestational age, malformation, need fo rehospitalization, etc.) among subgroups of women with, and without different disabilities will be compared. We will identify and meet with providers and support groups in the region ("community partners") to gain a fuller understanding of the most relevant questions and variables to explore, and to discuss the results, with a goal of developing future targeted assessments of outcomes, issues, or subgroups.