Pregnancy Outcomes in Women with Disabilities: Exploratory Research

描述（由申请人提供）：残疾妇女的生育率有所增加，尽管很少有研究检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病例系列。身体或智力残疾的妇女可能具有将她们或她们的婴儿置于不良后果风险增加的特征，因此重要的是要提高我们对她们如何实现健康结果和后代的理解。这是一个探索性项目的重新提交提案，该项目使用现有的基于人口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-出院记录来识别华盛顿州1987-2011年分娩时有身体、智力或其他残疾的妇女。将根据出院记录中的《国际疾病分类》编码确定近3 000例残疾妇女分娩。将以10：1的比例随机选择无残疾妇女作为对照组，频率与分娩年份相匹配。下文将介绍残疾妇女分娩的总体数量和比例，并按残疾类型分类。残疾妇女和非残疾妇女在个人和行为特征（分娩年龄、教育、孕前体重、吸烟状况等）方面的差异程度，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）将被衡量。妊娠条件的发生（例如，先兆子痫、妊娠期糖尿病）和结局（早产、剖腹产、婴儿低出生体重、小于胎龄儿、畸形、需要再住院等）将对有残疾和无残疾的妇女分组进行比较。我们将确定并会见该地区的供应商和支持团体（“社区合作伙伴”），以更全面地了解最相关的问题和变量，并讨论结果，目标是制定未来有针对性的评估结果，问题或子组。

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.