Perinatal & Pediatric
The Association of Maternal Intellectual and Developmental Disabilities with Infant Death in California Catherine Psaras* Catherine Psaras Gretchen Bandoli Rita Ryu
Background. Intellectual and developmental disabilities (IDD) involve cognitive and adaptive deficits that begin before age 18–22. While fertility rates among individuals with IDD are rising alongside recognition of their reproductive rights, they still face significant health disparities during pregnancy. This study aimed to examine the relationship between maternal IDD subtypes and infant death. Methods. This population-based study analyzed linked data from California (2007–2021), including birth, infant death, discharge, emergency department, and ambulatory surgery center records. We compared singleton births to women with preexisting IDD (autism [ASD], cerebral palsy [CP], intellectual disability [ID], chromosomal abnormalities, and other IDD) to those without IDD, using ICD codes to identify disabilities. We limited IDD subtype-specific analyses to ID and chromosomal abnormalities due to the low number of deaths in other IDD subtypes. The primary outcome was infant death within the first year of life, identified via infant death certificates. Relative risks from modified Poisson regressions and hazard ratios from Cox proportional hazards models were adjusted for maternal age at birth and the competing risk of death where appropriate. Results. The data included 6,430,534 singleton infants born from 2007–2021. Of these, 4,713 were born to women with IDD (non-mutually exclusive subtypes: ASD: 458; CP: 1019; ID: 1817; chromosomal abnormalities: 1571; other IDD: 600). Infants of mothers with any IDD had significantly elevated hazards of death due to all causes (all COD HR: 9.38 [7.79, 11.30]). When analyzed by IDD subtype, there was heterogeneity (all COD HR [95% CI]: ID: 7.25 [4.78, 11.02]; chromosomal abnormalities: 17.03 [13.40, 21.65]). Discussion. Infants of women with IDD face significantly higher risks of infant death. Given the increasing fertility rates in this population, further research is essential to develop strategies to prevent infant mortality.