Online Program

Postpartum hospital readmissions among women with intellectual and developmental disabilities

Monday, November 2, 2015 : 12:50 p.m. - 1:10 p.m.

Hilary Brown, PhD, Women's College Research Institute, Toronto, ON, Canada
Virginie Cobigo, PhD, School of Psychology, University of Ottawa, Ottawa, ON, Canada
Yona Lunsky, PhD, Dual Diagnosis Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
Simone Vigod, MD, MSc, Psychiatry, Women's College Hospital, Toronto, ON, Canada
Postpartum hospital readmission is an indicator of significant maternal morbidity. Women with intellectual and developmental disabilities (IDD) may be particularly vulnerable to poor medical and psychiatric outcomes during the postpartum period; however, this has not been previously examined. Our objective was to compare the risks of postpartum medical and psychiatric hospital readmissions among women with and without IDD. We conducted a population-based cohort study using Ontario (Canada) health and social services administrative data. We identified singleton live births to women with (N=3,869) and without (N=380,680) IDD (2002-2011 fiscal years). We used modified Poisson regression to estimate the risks of postpartum hospital readmission (total, medical, psychiatric) within 12 weeks of delivery discharge. We also examined readmissions within 7 days and between 8 days and 12 weeks. Multivariable models controlled for baseline social and health characteristics, including pre-existing mental health issues. Women with IDD were at increased risk for postpartum hospital readmission within 12 weeks (10.9% vs. 2.1%; aRR=3.41, 95% CI 3.13-3.94), including psychiatric (9.6% vs. 1.0%) but not medical (1.6% vs. 1.1%) readmissions. They were at increased risk for readmission both within 7 days (10.1% vs. 1.5%; aRR=4.24, 95% CI 3.74-4.80) and between 8 days and 12 weeks (1.6% vs. 0.7%; aRR=1.77, 95% CI 1.36-2.31). In both time periods, risks were driven by psychiatric readmissions. The high rates of postpartum hospital readmission among women with IDD, particularly for psychiatric reasons, show that there is an urgent need for enhanced supports for women with IDD during the postpartum period.

Learning Areas:

Program planning
Public health or related nursing
Public health or related public policy

Learning Objectives:
Compare the risks of postpartum hospital readmission among women with and without intellectual and developmental disabilities. Identify the major reasons for postpartum hospital readmission (i.e., medical vs. psychiatric) among women with intellectual and developmental disabilities.

Keyword(s): Disabilities, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am funded by a Canadian Institutes of Health Research Postdoctoral Award to study reproductive and perinatal health issues among women with intellectual disabilities. My research experience in psychiatric and perinatal epidemiology uniquely qualify me to undertake this research. My broader interests relate to the impact of chronic maternal disease and disability on obstetric and pediatric outcomes. My goal is to identify high risk groups to which targeted interventions can be applied to optimize outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.