title: Pregnancy outcomes of women with physical disabilities: a matched cohort study.
abstract: OBJECTIVE
  To document pregnancy outcomes of women with moderate-to-severe physical disabilities and to evaluate maternal and fetal outcomes compared with those of nondisabled 1:1 matched controls within the same hospital system.
  
  
  METHODS
  A retrospective matched cohort.
  
  
  METHODS
  A multidisciplinary outpatient reproductive health care clinic for women with physical disabilities, situated in an urban rehabilitation hospital and affiliated with a large tertiary medical care center.
  
  
  METHODS
  Women with physical disabilities.
  
  
  METHODS
  A chart review of 755 women with physical disabilities who were seen at a multidisciplinary specialty reproductive health care clinic, in which 48 total pregnancies of 34 women with physical disabilities were found. Thirty-four of these pregnancies were carried to delivery in 25 of these women with physical disabilities.
  
  
  METHODS
  Obstetric and disability-related pregnancy and delivery complications.
  
  
  RESULTS
  Twenty-nine of the 34 pregnancies (85%) occurred in women with moderate-to-severe neurologic disabilities who were wheelchair users, with 33 resultant infants (1 twin pregnancy), and 2 instances of intrauterine fetal demise. Forty percent of the women delivered prematurely, although only 3 of 34 delivered before 32 weeks (9%). Thirty-four percent of the infants (12) were of low birthweight, all of whom were preterm. Although there was a higher rate of pregnancy-related complications (P = .003) in the disabled cohort, there were no maternal deaths, and few of the complications were severe or life threatening. Rates of urinary tract infections and other maternal infections were significantly higher in the disabled cohort and were correlated with both increased preterm delivery and lower birthweight infants (P = .009 and 0.023, respectively). Thirty-eight percent of the infants were delivered by cesarean section. The disabled cohort had lower rates of augmentation of labor (P = .03) and breastfeeding (P = .02) compared with nondisabled controls. Although bladder and functional status changes were noted during the pregnancies of women with physical disabilities, these women reverted to their prepregnancy functional status by 6 weeks postpartum.
  
  
  CONCLUSIONS
  Our study describes a cohort of women who had moderate-to-severe physical disabilities who historically have been discouraged from pregnancy. Women with physical disabilities experienced higher rates of preterm deliveries, low birthweight infants, and pregnancy complications. The pregnancy complications in most cases were not severe and were readily managed. Although it was common to experience functional changes during pregnancy, these changes had largely resolved by 6 weeks postpartum. Larger observational studies are needed to better understand the etiology and prevention of preterm labor and low-birthweight infants in this population, and, in particular, the role of maternal infections.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, 325 E Eisenhower Pkwy, Suite 100, Ann Arbor, MI 4810, USA. cmmorton@med.umich.edu
authors.forename: Christina
authors.initials: C
authors.lastname: Morton
authors.forename: Joan T
authors.initials: JT
authors.lastname: Le
authors.forename: Lena
authors.initials: L
authors.lastname: Shahbandar
authors.forename: Cassing
authors.initials: C
authors.lastname: Hammond
authors.forename: Eileen A
authors.initials: EA
authors.lastname: Murphy
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Kirschner
mesh_terms: D000328:Adult; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D007752:Obstetric Labor, Premature / Q000453:epidemiology*; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology