There is strong evidence from around the globe that people who are poor and less educated have more health problems and die earlier than those who are richer and more educated, [1][1] and these disparities exist even in wealthy countries like Canada.[2][2] To make an impact on improving health

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Taking action on the social determinants of health in clinical practice: a framework for health professionals

Objectives The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth. Methods Data from the 2002-2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed. Results Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6-15.6 compared with 8.9%; 95% CI, 8.5-9.3 for women without disabilities) and low-birth-weight babies (10.3%; 95% CI, 9.4-11.2 compared with 6.8%; 95% CI, 6.8-6.9). There was no difference in the rates of cesarean section between women with and without disabilities. Conclusions These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.

Maternal Characteristics, Pregnancy Complications, and Adverse Birth Outcomes Among Women With Disabilities.

Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy.

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis.

Pregnancy among US women: differences by presence, type, and complexity of disability

Background The number of US women of childbearing age who have chronic physical disabilities (CPD) is increasing. However, little is known about their reproductive experiences. Historically, women with physical disabilities have confronted stigmatized attitudes about becoming pregnant. Objectives To explore the national prevalence of current pregnancy among women with and without CPD; examine differences in current pregnancy prevalence between these 2 groups of women. Research design Bivariable and multivariable analyses of cross-sectional, nationally representative National Health Interview Survey data from 2006 to 2011. Subjects Forty-seven thousand six hundred twenty-nine civilian, noninstitutionalized women aged 18-49 years. Measures National Health Interview Survey asks women ages 18-49 if they are currently pregnant; it also asks about various movement difficulties. We used responses from 8 movement difficulty and other questions to identify women with CPD. Results Six thousand forty-three (12.7%) sampled women report CPD. Compared with other women, women with CPD are significantly: older; more likely to be black and less likely to be Asian or Hispanic; more likely to be divorced or separated; more likely to have less than a high school education; less likely to be employed; and have much lower incomes. Across all women, 3.5% report being currently pregnant: 3.8% of women without CPD and 2.0% with CPD. Controlling for sociodemographic factors, the adjusted odds ratio (95% confidence interval) of current pregnancy is 0.83 (95% confidence interval, 0.65-1.05; P=0.12) for women with CPD compared with nondisabled women. Conclusions Women with CPD do become pregnant, and their numbers will likely grow. Obstetrical practitioners therefore require training about the special needs of these women.

Prevalence of current pregnancy among US women with and without chronic physical disabilities.

Background: Routine prenatal care includes physical examinations and weight measurement. Little is known about whether access barriers to medical diagnostic equipment, such as examination tables and weight scales, affect prenatal care among pregnant women with physical disabilities. Methods: We conducted 2-hour, in-depth telephone interviews with 22 women using a semistructured, open-ended interview protocol. All women had significant mobility difficulties before pregnancy and had delivered babies within the prior 10 years. We recruited most participants through social networks. We sorted interview transcript texts using used NVivo software and conducted conventional content analyses to identify major themes. Results: Interviewee's mean (standard deviation) age was 34.8 (5.3) years. Most were white, well-educated, and higher income; 8 women had spinal cord injuries, 4 cerebral palsy, and 10 had other conditions; 18 used wheeled mobility aids. Some women's obstetricians had height adjustable exami...

Physical Accessibility of Routine Prenatal Care for Women with Mobility Disability

General health, health conditions, and current pregnancy among U.S. women with and without chronic physical disabilities

“How did that happen?” Public responses to women with mobility disability during pregnancy

Objective
Little is known about how functional impairments might affect the pregnancies of women with mobility disability. We aimed to explore complications that arise during pregnancy that are specifically related to physical functional impairments of women with significant mobility disabilities.

Design
Qualitative descriptive analysis.

Setting
Telephone interviews with women from 17 USA states.

Sample
22 women with significant mobility difficulties who had delivered babies within the prior 10 years; most participants were recruited through social networks.

Methods
We conducted 2-h, in-depth telephone interviews using a semi-structured, open-ended interview protocol. We used NVIVO software to sort interview transcript texts for conventional content analyses.

Main outcome measures
Functional impairment-related complications during pregnancy.

Results
The women's mean (standard deviation) age was 34.8 (5.3) years. Most were white, well-educated, and higher income; eight women had spinal cord injuries, four cerebral palsy, and 10 had other conditions; 18 used wheeled mobility aids; and 14 had cesarean deliveries (eight elective). Impairment-related complications during pregnancy included: falls; urinary tract and bladder problems; wheelchair fit and stability problems that reduced mobility and compromised safety; significant shortness of breath, sometimes requiring respiratory support; increased spasticity; bowel management difficulties; and skin integrity problems (this was rare, but many women greatly increased skin monitoring during pregnancy to prevent pressure ulcers).

Conclusions
In addition to other pregnancy-associated health risks, women with mobility disabilities appear to experience problems relating to their functional impairments. Pre-conception planning and in-depth discussions during early pregnancy could potentially assist women with mobility disabilities to anticipate and address these difficulties.

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Amy J. Wint

Papers

Prevalence of current pregnancy among US women with and without chronic physical disabilities.

Physical Accessibility of Routine Prenatal Care for Women with Mobility Disability

General health, health conditions, and current pregnancy among U.S. women with and without chronic physical disabilities

“How did that happen?” Public responses to women with mobility disability during pregnancy

Effects of disability on pregnancy experiences among women with impaired mobility.