Perinatal & Pediatric
Hypertensive disorders of pregnancy among women with intellectual disability: a population-based study Rita Ryu* Rita Ryu Catherine Psaras Gretchen
Background. Women with intellectual and development disabilities (IDD) face increased risk of adverse maternal outcomes. Among IDD subtypes, intellectual disability (ID) may confer unique risks, but these are poorly understood due to low prevalence. Thus, we investigated associations between women with ID and hypertensive disorders of pregnancy. Methods. This study used a cohort derived from linking 2007-2020 California birth and fetal death records with hospital discharge, emergency department, and ambulatory surgery data. From 6,099,797 singleton births, we created a 1:3 matched cohort of women with and without ID, exact matched on age, race/ethnicity, payer type, participation in a supplemental nutrition program, and maternal nativity. ID status and outcomes were identified from International Classification of Diseases codes at delivery. Generalized linear modeling was applied to estimate risk measures, and mediation analysis was used to calculate the proportion mediated by chronic comorbidities and lifestyle characteristics. Results. Among the matched cohort, women with ID (n=1,107) had higher risks of gestational hypertension (RR: 1.8, 95%CI: 1.5,2.2), preeclampsia (RR: 2.8: 2.2,3.5), and severe maternal morbidity (SMM) (RR: 3.4: 2.7,4.4), compared to women without ID (n=3,321). Gestational hypertension was partially mediated by anxiety (proportion mediated: 23%), epilepsy (10%), respiratory conditions (8%), and preexisting diabetes (8%). For preeclampsia, significant mediators were preexisting hypertension (25%), anxiety (14%), preexisting diabetes (11%), epilepsy (10%), and depression (8%), and strongest for SMM were epilepsy (18%), respiratory conditions (13%), and preexisting hypertension (11%). Discussion. Women with ID face elevated risks of hypertensive disorders of pregnancy, which are partially explained by chronic comorbidities. Future studies will conduct multiple mediation analyses to inform interventions aimed at improving maternal health.