Improving pregnancy outcomes for women with intellectual and developmental disabilities in Medicaid

项目摘要 智力和发育障碍(IDD)妇女面临污名和医疗不平等 围绕生育权和怀孕。制度化和强制绝育过去是，现在仍然经常 太普遍了。缺碘妇女缺乏机会限制了我们对集体怀孕的了解 已经面临经济、健康和教育方面的不平等。确定围产期干预措施是至关重要的 孕妇患有碘缺乏病，因为她们面临更高的孕产妇发病率风险和不良的出生结局。 获得孕前医疗补助降低了产妇发病率，但参保政策因州而异。 了解患有IDD的孕妇何时登记参加医疗补助可能是增加 产前护理的机会。在一般人群中，及时和高质量的产前护理可以减少 产妇发病、早产和再次住院的风险。我们不知道产前护理如何影响 碘缺乏病妇女的结局。医疗补助家庭和社区服务(HCBS)豁免允许 帮助IDD患者在他们的社区蓬勃发展的额外服务(如交通)，但豁免如何 影响获得产前护理的机会尚不清楚。我们的目标是使用国家数据，结合定性 对患有IDD的妇女进行访谈，以确定在#年减少孕产妇发病率的最佳做法和政策 医疗补助计划招募了患有IDD的妇女。我们建议使用医疗补助覆盖的怀孕数据对患有 2011-2022年IDD(N&>T；72,000)，以确定孕前医疗补助登记、产前护理的影响 充分性，以及HCBS对妊娠期糖尿病、早产和再次住院的豁免收据 患有IDD。同时，患有IDD的女性是她们经验方面的专家，我们将进行定性访谈 与正在或曾经怀孕的IDD妇女一起捕捉整个IDD妇女的生活经历 生殖课程，特别强调产前护理和医疗保险登记。我们的目标 是描述IDD妇女的孕前医疗补助登记情况，并检查怀孕前 登记与减少早产、妊娠期糖尿病和产后住院有关； 2)描述缺碘妇女产前护理的时机和充分性，并检查产前护理是否充分 与早产、妊娠期糖尿病和产后住院的减少有关；3)描述 IDD孕妇HCBS减免收据和服务类型的模式及是否存在HCBS 收据和类型与产前护理充分性和产后住院有关；4)调查 卫生保健和法律障碍，改善妊娠保健和结局的机会，并告知 通过对IDD妇女进行半结构化访谈进行分析。我们的方法使用定量和 定性数据，以确定最终将制定的个人护理和州一级政策中的关键因素 转变为干预措施以及国家和国家政策。随着越来越多的患有IDD的女性开始组建家庭，我们的工作是 确保患有IDD的孕妇茁壮成长是至关重要的。

Project Abstract Women with intellectual and developmental disabilities (IDD) face stigmatization and healthcare inequity surrounding reproductive rights and pregnancy. Institutionalization and forced sterilization were, and still often are, too common. A lack of opportunity for women with IDD has limited our knowledge of pregnancy in a group already facing economic, health, and educational inequities. It is crucial to identify perinatal interventions for pregnant women with IDD because they face increased risk of maternal morbidity and poor birth outcomes. Access to Medicaid pre-pregnancy reduces maternal morbidity but enrollment policies differ by state. Understanding when pregnant women with IDD enroll for Medicaid may be a pivotal tool in increasing opportunity for prenatal care. In the general population, timely and high-quality prenatal care can reduce the risk of maternal morbidity, preterm birth, and rehospitalization. We do not know how prenatal care impacts outcomes for women with IDD. Medicaid Home and Community Based Services (HCBS) waivers allow for additional services (e.g., transportation) that help people with IDD thrive in their communities, but how waivers impact access to prenatal care are not known. Our goal is to use national data, in conjunction with qualitative interviews of women with IDD, to identify optimal practices and policies that reduce maternal morbidity in Medicaid enrolled women with IDD. We propose to use data of Medicaid covered pregnancies to women with IDD (N>72,000) from 2011-2022 to identify impacts of pre-pregnancy Medicaid enrollment, prenatal care adequacy, and HCBS waiver receipt on gestational diabetes, preterm birth, and re-hospitalization in women with IDD. In parallel, women with IDD are experts in their experience and we will conduct qualitative interviews with women with IDD who are or were pregnant to capture the lived experience of women with IDD throughout the reproductive course, with specific emphasis on prenatal care and health insurance enrollment. Our aims are to Describe pre-pregnancy Medicaid enrollment in women with IDD and examine if pre-pregnancy enrollment is associated with reduction in preterm birth, gestational diabetes, and post-partum hospitalization; 2) Describe timing and adequacy of prenatal care in women with IDD and examine if adequacy of prenatal care is associated with reduction in preterm birth, gestational diabetes, and postpartum hospitalization; 3) Describe patterns in HCBS waiver receipt and type of services used in pregnant women with IDD and examine if HCBS receipt and type are associated with prenatal care adequacy and post-partum hospitalization; 4) Investigate health care and legal barriers, opportunities to improve pregnancy care and outcomes and inform quantitative analyses by conducting semi-structured interviews with women with IDD. Our approach uses quantitative and qualitative data to identify key factors in individual care and state level policy that will ultimately be developed into interventions and state and national policies. As more women with IDD start families, our work is fundamental in ensuring that pregnant women with IDD thrive.