Article

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.
DESIGN: A retrospective matched cohort. SETTING:
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. POPULATION: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS