title: Pregnancy Characteristics and Outcomes among Women at Risk for Disability from Health Conditions Identified in Medical Claims.
abstract: Women with disabilities are at risk for poor birth outcomes. Little is known about specific potentially disabling health conditions and their effects on pregnancies. Using hospital claims, we identified women at risk for disability and evaluated the relationship between disability risk and demographic characteristics, pregnancy risks, and infant and maternal outcomes.
  
  
  
  The 2006 through 2009 Massachusetts Pregnancy to Early Life Longitudinal data system linked birth certificate and hospital claims one year pre-pregnancy through delivery. Access Risk Classification System categorized International Classification of Diseases, Ninth Revision, Clinical Modification/Current Procedural Terminology codes into disability risk groups (no/limited vs. medium/high). Generalized estimating equations evaluated the association between disability risk and infant and maternal outcomes.
  
  
  
  Of 221,867 women, 14,701 (6.6%) were at medium or high risk of disability. Health conditions were classified as circulatory (23%), musculoskeletal (10%), nervous system/sensory (13%), other physical (19%), two or more physical (5%), mental illness (24%), and comorbid mental/physical (6%). Women at risk of disability were more likely than others to have socioeconomic and pregnancy risks, and adverse infant and maternal outcomes. Socioeconomic and risk profile varied by health condition category. Adjusted risk ratios for preterm birth ranged from 1.2 (95% confidence interval [CI], 1.1-1.4) for women with nervous system/sensory diagnoses to 1.6 (95% CI, 1.4-1.9) for women with two or more physical diagnoses; risk ratios for maternal delivery hospitalization for more than 5 days ranged from 1.5 (95% CI, 1.2-1.9) for women with musculoskeletal diagnoses to 3.0 (95% CI, 2.5-3.6) for women with comorbid mental/physical diagnoses.
  
  
  
  Disability risk identified through claims is associated with poor infant and maternal outcomes. Risk profiles vary by underlying health condition.
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: Karen.clements@umassmed.edu.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Clements
authors.affiliation: Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
authors.forename: Monika
authors.initials: M
authors.lastname: Mitra
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
authors.affiliation: The Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
mesh_terms: D000328:Adult; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008404:Massachusetts / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult