DESCRIPTION (provided by applicant): An estimated 8 million U.S. women of childbearing age have a disability. As medical advances have facilitated longer lifespans and more active lives for women with disabilities, interest in childbearing in this population has increased. However, women with disabilities still face substantial barriers to successful and healthy pregnancies. Unfortunately, our understanding of the prevalence of pregnancy, the extent of adverse outcomes, and the factors associated with such outcomes among women with disabilities, remains limited. The statistics that are available suggest greater risk of infections preterm birth, and cesarean delivery for mothers with disabilities. Infants born to women with disabilities are more likely to be low birth weight or small for gestational age, and are at increased risk of perinatal death. However, there is little information at a population level about the course and outcomes of pregnancy in women with disabilities. Furthermore, there is a dearth of data on what proportion of women with disabilities even experience pregnancy. The objective of the proposed project is to address these key knowledge gaps by using both national and state level data to study prevalence and outcomes of pregnancy in women with and without disabilities. Specifically, we will: 1) establish the prevalence of pregnancy among women with disabilities overall, and with particular types of disabilities, compared to women without disabilities~ 2) identify the prevalence and correlates of adverse pregnancy outcomes among women with disabilities~ and 3) determine the independent association of disability with adverse pregnancy outcomes. We will use data from the Medical Expenditure Panel Survey (MEPS) to identify the characteristics of women with disabilities who were pregnant during their panel participation and estimate the size of this population. We will use both the MEPS and hospital discharge and birth certificate data from California to generate new knowledge about outcomes of pregnancy in women with disabilities, risk factors for adverse outcomes, and the unique role of disability in contributing to adverse outcomes above and beyond other risk factors. This exploratory research will move the field forward by utilizing data from large, representative data sources, which will allow us to study relatively rare pregnancy and neonatal outcomes that cannot be researched adequately using smaller samples. Achievement of our aims will provide crucial knowledge about the perinatal issues of women with disabilities, a population that is likely to be particularly vulnerable to adverse outcomes. Our findings will enable clinicians to provide more informed preconception care and counseling for women with disabilities, and may influence family-planning and associated healthcare decisions of women with disabilities. Our results will also have important implications for enhancing prenatal, delivery, and postpartum care for mothers with disabilities and their infants.

PUBLIC HEALTH RELEVANCE: Enabling women with disabilities to enjoy safe and healthy pregnancies, and illuminating factors that may impede that process, are key components in promoting health, independence, and well-being of individuals with disabilities. The proposed research addresses national public health priorities of increasing data on disability-related health disparities and facilitating reduction of such disparities. The project also furthers NICHD' mission to ensure that every person is born healthy and that women suffer no harmful effects from the reproductive process.