Pregnancy outcomes in women with intellectual disability. A cohort study using linked Swedish population-based registers (IDcare)
IASSIDD 2024 - Chicago (USA), August 5-8 2024
Kristina Edvardsson, Ingrid Mogren, Anna Axmon
[View presentation] [Project main site]
Due to changes in the definition of the gPop cohort as well as the chosen statistical methodology, the numbers below and in the presentation differ slightly from those that were provided in the book of abstracts.
Background: Women with intellectual disability (ID) may encounter barriers to exercising reproductive agency, self-care during pregnancy, and accessing healthcare to optimize pregnancy outcomes. However, there is to date little evidence to guide policy and practice. We aim to fill this identified knowledge gap by examining pregnancy outcomes among women with ID in comparison with women from the general population.
Methods: Data were drawn from the IDcare cohort, in which all people living in Skåne in 2014 were included. The original study cohorts comprised 5939 women with ID and 620032 women from the general population (gPop; comparison). Of these, 382 and 66732, respectively, had at least one delivery during the study period (2014-2021). To avoid statistical dependence, our analyses were limited to the first recorded pregnancy for each woman. For each investigated pregnancy outcome, we estimated the risk associated with the ID cohort compared to the gPop cohort, using Poisson regression to determine relative risks (RRs).
Findings: Women with ID were younger than the general population at the first recorded pregnancy (27 vs 31 years, p<0.001). They were however as likely to only have one delivery during the study period (68% vs 64%; RR 1.05). The most common mode of delivery in both groups was single spontaneous delivery (73.6% in the ID cohort and 74.7% in the gPop cohort), followed by single delivery by caesarean delivery (17.3% and 16.4%; RR 1.23), single delivery by forceps and vacuum extraction (7.3% and 7.2%; RR 1.01), multiple delivery (n<5 and 1.4%), and other assisted single delivery (n<5 and 0.3%). However, women with ID were more likely to experience failed induction of labor (26% vs 20%; RR 1.28).
Conclusions: The disparities in outcomes support the need for improved pregnancy care and support for women with ID.
Research group
Associate professor Magnus Sandberg (PI for IDcare)
Associate professor Anna Axmon (PI for the covid follow-up study)
Professor Ulf Gerdtham
Associate professor Jimmie Kristensson
Collaborations
Ass prof Julia Bahner, Lund University, Sweden
Dr Trine Lise Bakken, Oslo University Hospital, Norway [prevalence of schizophrenia]
Dr Petra Björne, City of Malmö, Sweden
Prof Darren Chadwick, Liverpool John Moores University, UK
Prof David Edvardsson, La Trobe University, Melbourne, Australia [dementia]
Prof Kristina Edvardsson, La Trobe University, Melbourne, Australia [pregnancy outcomes]
Dr Karin Engström, Lund University, Sweden
Dr Hanna Falk Erhag, University of Gothenburg, Sweden
Dr Alessandra Grotta, Stockholm University, Sweden
Ass prof Björn Hofvander, Lund University, Sweden
Prof Silke Kern, University of Gothenburg, Sweden
Dr Katarina Lauruschkus, Lund University, Sweden
Dr Can Liu, Stockholm University and Karolinska Institutet, Sweden
Prof Yona Lunsky, University of Toronto, Canada
Ass prof Hugo Lövheim, Umeå University, Sweden [dementia]
Dr Emilie Stroh, Lund University, Sweden [care transitioning] [diabetes]