Primary cesarean delivery patterns amongwomen with physical, sensory, or intellectual disabilities

Blair G. Darney, Frances M. Biel, Brian P. Quigley, Aaron B. Caughey, Willi Horner-Johnson

Research output: Research - peer-reviewArticle

Abstract

Background: Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective: This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods: We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results: In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94-2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46-8.53). Conclusions: Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.

LanguageEnglish (US)
JournalWomen's Health Issues
DOIs
StateAccepted/In press - 2017

Fingerprint

Intellectual Disability
disability
Developmental Disabilities
Parity
Comorbidity
Odds Ratio
Confidence Intervals
comorbidity
confidence
Birth Certificates
Gestational Diabetes
International Classification of Diseases
Insurance
Cohort Studies
Retrospective Studies
Logistic Models
Mothers
Wounds and Injuries
Research
Population

ASJC Scopus subject areas

  • Health(social science)
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Maternity and Midwifery

Cite this

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title = "Primary cesarean delivery patterns amongwomen with physical, sensory, or intellectual disabilities",
abstract = "Background: Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective: This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods: We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results: In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94-2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46-8.53). Conclusions: Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.",
author = "Darney, {Blair G.} and Biel, {Frances M.} and Quigley, {Brian P.} and Caughey, {Aaron B.} and Willi Horner-Johnson",
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journal = "Women's Health Issues",
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T1 - Primary cesarean delivery patterns amongwomen with physical, sensory, or intellectual disabilities

AU - Darney,Blair G.

AU - Biel,Frances M.

AU - Quigley,Brian P.

AU - Caughey,Aaron B.

AU - Horner-Johnson,Willi

PY - 2017

Y1 - 2017

N2 - Background: Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective: This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods: We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results: In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94-2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46-8.53). Conclusions: Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.

AB - Background: Little is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity. Objective: This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. Methods: We conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity. Results: In our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94-2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46-8.53). Conclusions: Women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.

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