Women with disabilities are increasingly becoming pregnant, and may be as likely to become pregnant as women without disabilities. Growing research suggests pregnancy in women with disability is associated with an increased risk for adverse perinatal outcomes. Although a few studies have examined disability-related disparities in adverse birth outcomes, finding increased risk of low birthweight, preterm birth, and neonatal intensive care unit admission, the mechanisms for these associations are not well understood. One plausible mechanism is the increased risk of psychosocial stress experienced by women with disabilities in the perinatal period. Women with disabilities are at heightened risk for intimate partner violence (IPV) and mood disorders, yet the extent to which these risks affect pregnancy outcomes has not been studied. A more comprehensive understanding of psychosocial stress, namely IPV and depressive symptomatology, and its relation to adverse birth outcomes is critically needed to reduce morbidity and mortality rates among disabled mothers and their infants, reduce disparities in perinatal care between women with and without disabilities, inform the design of effective evidence-based interventions for this understudied and underserved population of women, and generate recommendations for clinical practice and policy change. To address this gap, we propose to systematically examine the association between psychosocial stress and adverse birth outcomes. Using a mixed method approach, we will: 1) examine the association between psychosocial stress (i.e., perinatal IPV and depressive symptomatology) and adverse birth outcomes (i.e., low birthweight, preterm birth) by analyzing data from PRAMS Phase 9 across women with and without disabilities; 2) explore the experiences and barriers to comprehensive perinatal care through individual interviews with ethnically and racially diverse pregnant and new mothers with diverse disabilities; and 3) explore facilitators and barriers (e.g., disability-related knowledge, attitudes, and pregnancy care experience) to the provision of comprehensive perinatal health care to women with disabilities through focus groups and individual in-depth interviews with health care providers who care for pregnant women with disabilities with the goal of improving perinatal care for this underserved group of women. This research will also serve as the foundation for the development and evaluation of future prevention interventions, including our own team’s planned submission to adapt, tailor, and test existing successful health promotion interventions to prevent violence and its related sequelae among women with disability, thereby optimizing pregnancy outcomes for women of childbearing age living with disability.

Project narrative Women with disabilities are at heightened risk for intimate partner violence (IPV), and mood disorders, yet the extent to which these risks affect pregnancy outcomes has not been studied. The proposed study will leverage existing population-based data, and will integrate qualitative data designed to improve the understanding of the role of context, risk, and protective factors for IPV and depression among women with disabilities.