The associations between maternal disability and perinatal outcomes among Black and/or Hispanic women in PRAMS

BACKGROUND: Women racialized as Black and/or Hispanic have high rates of adverse perinatal outcomes due to systemic racism. It is unknown if rates are higher among Black and/or Hispanic women with disabilities, who may experience additional barriers to perinatal healthcare, including disability-based discrimination (i.e., ableism). Therefore, we examined the associations between maternal disability and preterm birth (< 37 weeks' gestation), low birthweight (< 2500 g), small for gestational age (< 10th percentile), and attendance at a postpartum health visit among Black and/or Hispanic women. METHODS: We conducted a cross-sectional study of Pregnancy Risk Assessment Monitoring System (PRAMS) data from participants who identified as Black and/or Hispanic between 2018 and 2019 across 22 jurisdictions (N = 9,034). Maternal disability was the primary exposure measured using the Washington Group-Short Set of Questions on Functioning, which asks respondents to rate their level of difficulty seeing, hearing, walking or climbing steps, remembering or concentrating, self-care, and communicating. Response options include "no difficulty," "some difficulty," "a lot of difficulty," and "I cannot do this at all." We examined differences in perinatal outcomes by overall disability status, disability severity, and disability type. We adjusted for demographic and clinical factors using multivariable logistic regression. RESULTS: The prevalence of disability was 7.7%. There were no significant differences in preterm birth or low birthweight by maternal disability. Participants with any disability were significantly less likely to have a small for gestational age infant (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI] = 0.37, 0.86) and to attend the postpartum visit compared to participants without disabilities (aOR = 0.38, 95% CI = 0.25, 0.57). We also found that as the level of self-reported difficulty increased, the odds of attending a postpartum health visit significantly decreased. Participants who reported blindness/low vision, cognition disability, communication disability, or multiple disabilities had significantly lower odds of attending the visit compared to participants without disabilities. CONCLUSIONS: Maternal disability was associated with lower odds of attending a postpartum health visit among Black and/or Hispanic participants in PRAMS, while small for gestational age differed by disability status and severity. Future research should identify barriers to postpartum healthcare for Black and/or Hispanic women with disabilities to inform culturally and disability-specific interventions.