Deeper Research Needed on Neonatal Outcomes for Infants of Mothers with Disabilities

Better understanding risk factors for infants of mothers with disabilities

In a compelling commentary published in Pediatrics, three leading experts in neonatal and perinatal medicine called for more research to better understand risk factors affecting infants born to mothers with disabilities, highlighting the importance of developing targeted interventions for this vulnerable population.

Kathleen Hannan, MD, Sunah Hwang, MD, PhD, and Stephanie Bourque, MD, of Children’s Hospital Colorado have collaborated on dozens of published studies that look at evaluating and improving neonatal outcomes, often with a focus on disparities in maternal and infant health outcomes.

Their commentary discussed the population-based cohort study, “Neonatal Outcomes of Mothers with a Disability,” by Brown et al, which was published in the September 2022 issue of Pediatrics.

They noted the growing body of perinatal research dedicated to vulnerable populations, including minority racial and ethnic groups, residents of rural areas and individuals with certain medical conditions. These populations are at increased risk for adverse birth outcomes, including prematurity, low birth weight, other neonatal morbidities and mortality.

Women with disabilities are another population at greater risk, yet they have not been well-studied. There is limited comprehensive evaluation of how maternal disability could impact other adverse neonatal outcomes.

In the study, a large data set was used to examine if different maternal disabilities are linked to increased neonatal complications, and it compared pregnant women with no disability to pregnant women with documented disability.

Risk for neonatal morbidities increased in pregnant women with disabilities

There was a mild-to-moderate increased risk for neonatal morbidities in pregnant women with disabilities, especially those with intellectual or developmental disability or multiple disabilities.

All groups of pregnant women with disabilities had increased adjusted risk for neonatal morbidities, risk for NICU admission, rates of mental illness and rates of smoking while pregnant.

Additionally, women with multiple disabilities were more likely to experience substance use disorder compared to those without a disability

Important factors not included in the study

Drs. Hannan, Hwang and Bourque highlighted several key factors missing from the analysis. These included:

• Maternal birth status: There is a known link to intergenerational risk for adverse birth outcomes.
• Maternal race and ethnicity data: This important social construct requires thoughtful reflection when assessing birth outcomes.
• Variables showing presence and degree of familial and community support: In particular, relationship status could be included in the data set. This would provide a better understanding of the support in place for a pregnant mother, which is an important consideration
• Smoking status: This was known but not was included in adjusted models, and it is a significant risk factor for preterm birth and low birth weight.
• Assessment of difference between quantity and quality of prenatal care: Previous studies found women with certain types of disabilities received inadequate or no prenatal care

Further research and the development of interventions for pregnant mothers with disabilities are needed

The study emphasized the need for ongoing research to identify barriers and ways to improve birth outcomes for this population. The need for more work determining and measuring how disabilities in the birthing population could be further impacted with the co-occurrence of other known perinatal risk factors was also noted in the commentary.

To address these issues, commentary authors noted existing perinatal programs may need to be adjusted and new programs for pregnant women with disabilities may need to be developed. The Nurse-Family Partnership project was presented as an example. The program conducts maternal home visits from early pregnancy through prenatal period for women with identified risk factors and is a model that could be adapted to include women with disabilities.

Drs. Hannan, Hwang and Bourque credited the study authors for beginning to describe birth outcomes associated with this population and setting the stage for additional analysis and targeted interventions.