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Maternal outcomes among women with intellectual disabilities in comparison with the general population (IDcare)

Axmon, Anna LU orcid ; Liu, Can ; Grotta, Alessandra ; Edvardsson, Kristina and Sandberg, Magnus LU orcid (2025) In AJOG global reports 5(4).
Abstract

BACKGROUND: Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.

OBJECTIVES: Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with... (More)

BACKGROUND: Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.

OBJECTIVES: Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.

STUDY DESIGN: This was a register study based on all women living in Skåne, Sweden on January 1
st, 2104, with at least 1 singleton birth in 2014-2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.

RESULTS: In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15-2.42), infections of the genitourinary tract (2.30, 1.67-3.16), premature rupture of membranes (2.42, 1.24-4.69 for women with mild intellectual disability), and false labor (1.27, 1.05-1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.

CONCLUSIONS: Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
delivery, obstetric, intellectual disability, pregnancy complications, reproduction, routinely collected health data
in
AJOG global reports
volume
5
issue
4
article number
100569
pages
11 pages
publisher
Elsevier
external identifiers
  • scopus:105018631582
  • pmid:41127054
ISSN
2666-5778
DOI
10.1016/j.xagr.2025.100569
project
Health care utilization in primary and specialist care among people with intellectual disability: A longitudinal register study
Pregnancy in intellectual disability: a register study to enable development of support for well-being in pregnancy through identification of risk factors and undesired outcomes
language
English
LU publication?
yes
additional info
© 2025 The Authors.
id
2107580a-dcae-4c57-8486-bbbf58b4c6c7
date added to LUP
2025-10-27 11:42:51
date last changed
2025-10-28 04:01:05
@article{2107580a-dcae-4c57-8486-bbbf58b4c6c7,
  abstract     = {{<p>BACKGROUND: Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.</p><p>OBJECTIVES: Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.</p><p>STUDY DESIGN: This was a register study based on all women living in Skåne, Sweden on January 1<br>
 st, 2104, with at least 1 singleton birth in 2014-2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.<br>
 </p><p>RESULTS: In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15-2.42), infections of the genitourinary tract (2.30, 1.67-3.16), premature rupture of membranes (2.42, 1.24-4.69 for women with mild intellectual disability), and false labor (1.27, 1.05-1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.</p><p>CONCLUSIONS: Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.</p>}},
  author       = {{Axmon, Anna and Liu, Can and Grotta, Alessandra and Edvardsson, Kristina and Sandberg, Magnus}},
  issn         = {{2666-5778}},
  keywords     = {{delivery; obstetric; intellectual disability; pregnancy complications; reproduction; routinely collected health data}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{Elsevier}},
  series       = {{AJOG global reports}},
  title        = {{Maternal outcomes among women with intellectual disabilities in comparison with the general population (IDcare)}},
  url          = {{http://dx.doi.org/10.1016/j.xagr.2025.100569}},
  doi          = {{10.1016/j.xagr.2025.100569}},
  volume       = {{5}},
  year         = {{2025}},
}