title: Postpartum Acute Care Utilization Among Women with Intellectual and Developmental Disabilities.
abstract: BACKGROUND
  Women with intellectual and developmental disabilities have high rates of pregnancy complications. However, their postpartum health is largely unknown. We compared risks for postpartum hospital admissions and emergency department visits among women with and without intellectual and developmental disabilities.
  
  
  METHODS
  We conducted a population-based study using linked Ontario (Canada) health and social services administrative data to identify singleton live births to women with (N = 3,803) and without intellectual and developmental disabilities (N = 378,313) (2002-2012). Outcomes were hospital admissions and emergency department visits in the 42 days following delivery discharge. We classified these as medical or psychiatric depending on the recorded primary discharge diagnosis.
  
  
  RESULTS
  Women with intellectual and developmental disabilities, compared to those without, had increased risk for postpartum hospital admissions overall (2.4% vs. 1.2%; adjusted hazard ratios [aHR]: 1.76, 95% confidence interval [CI]: 1.43-2.17) and for psychiatric reasons (0.8% vs. 0.1%; aHR: 10.46, 95% CI: 6.96-15.70), but not for medical reasons. They also had increased risk for postpartum emergency department visits overall (16.6% vs. 7.9%; aHR: 1.85, 95% CI: 1.71-2.01) and for both medical (15.8% vs. 7.8%; aHR: 1.80, 95% CI: 1.66-1.96) and psychiatric reasons (1.3% vs. 0.1%; aHR: 5.66, 95% CI: 4.17-7.69).
  
  
  CONCLUSIONS
  High rates of postpartum hospital admissions and emergency department visits among women with intellectual and developmental disabilities demonstrate that this group may be vulnerable to acute complications or inadequate preventive care after childbirth. Providing enhanced health services during the postpartum period, in the form of longer or more frequent visits or specialized supports, could optimize their outcomes following delivery.
authors.affiliation: 1 Women's College Research Institute , Women's College Hospital, Toronto, Canada .|2 Department of Psychiatry, University of Toronto , Toronto, Canada .|3 Institute for Clinical Evaluative Sciences , Toronto, Canada .
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Brown
authors.affiliation: 3 Institute for Clinical Evaluative Sciences , Toronto, Canada .|4 School of Psychology, University of Ottawa , Ottawa, Canada .
authors.forename: Virginie
authors.initials: V
authors.lastname: Cobigo
authors.affiliation: 2 Department of Psychiatry, University of Toronto , Toronto, Canada .|3 Institute for Clinical Evaluative Sciences , Toronto, Canada .|5 Centre for Addiction and Mental Health , Toronto, Canada .
authors.forename: Yona
authors.initials: Y
authors.lastname: Lunsky
authors.affiliation: 1 Women's College Research Institute , Women's College Hospital, Toronto, Canada .|2 Department of Psychiatry, University of Toronto , Toronto, Canada .|3 Institute for Clinical Evaluative Sciences , Toronto, Canada .
authors.forename: Simone
authors.initials: S
authors.lastname: Vigod
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology*; D009864:Ontario / Q000453:epidemiology; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D055815:Young Adult
keywords: epidemiology; health disparities; postpartum