Abstract
Introduction
As an increasing number of people with disabilities become pregnant and give birth,
understanding their vulnerabilities for poor mental health and life stress can help
to improve their health and well-being. We examined whether people with disabilities
are more likely to experience stressful life events 12 months before childbirth, postpartum
depressive symptoms (PDS), and lack of postpartum partner and social support, and
compared these associations by race/ethnicity.
Methods
Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016–2020 data
(n = 6,483), we used univariate and multivariable logistic regression models to estimate
the associations of disability with stressful life events, PDS, and postpartum partner
and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence
interval (CI). We also conducted stratified analyses by race/ethnicity.
Results
The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic
people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3%
among Asian non-Hispanic people. Compared with people without disabilities, those
with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36–1.74),
partner-related stress (RR, 2.55; 95% CI, 2.23–2.91), financial stress (RR, 1.55;
95% CI, 1.44–1.68), traumatic stress (RR, 2.27; 95% CI, 1.85–2.79), and PDS (RR, 3.77;
95% CI, 3.13–4.53). People with disabilities were also more likely to lack a partner's
emotional support (RR, 2.57; 95% CI, 2.21–2.97), financial support from the newborn's
father (RR, 2.89; 95% CI, 2.39–3.51), and social support while feeling tired or frustrated
(RR, 2.05; 95% CI, 1.68–2.52). These associations remained statistically significant
after adjustment for maternal factors and newborn's birth year. Strong associations
of disability with stressful life events (including emotional stress and partner-related
stress), PDS, lacking partner's emotional support, and social support existed across
racial/ethnic groups.
Conclusions
Pregnant people with disabilities may benefit from additional screening for stressful
life events and depression during pregnancy and postpartum. Multidisciplinary efforts
that combine mental health screening and treatment, peer support groups, increased
health care provider training about caring for people with disabilities during pregnancy
and better access to care for pregnant people with disabilities are needed to improve
their health and support their desire to become parents.
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Biography
Xiaoli Chen, MD, PhD, MPH, is an Epidemiologist of the Division of MCH Research and Analysis at the Massachusetts Department of Public Health. She has a track record of research accomplishments as evidenced by > 60 papers published in peer-reviewed journals with >5,000 citations.
Biography
As the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) Director, Emily Lu, MPH, brought over 15 years of experience in PRAMS implementation and MCH research. Emily Lu has published manuscripts on disability, infertility therapies, preterm birth, oral health, and safe sleep.
Biography
Sarah L. Stone, PhD, MPH, is a maternal and child health epidemiologist and serves as the Director of the Office of Data Translation, in the Division of Maternal and Child Health Research and Analysis at the Massachusetts Department of Public Health.
Biography
Oanh Bui, MHA, MA, manages Culturally Linguistically Appropriate Services initiatives at the Massachusetts Department of Public Health. Oanh has lived experience as a single immigrant mother of a child with complex disability and has been a cultural broker for the Vietnamese community.
Biography
Kimberley Warsett, BA, MSW, is a Program Coordinator in the Health and Disability Program at the Massachusetts Department of Public Health. She has worked extensively in the disability field and holds degrees from Stanford University and Boston University.
Biography
Hafsatou Diop, MD, MH, is the Director of the Division of MCH Research and Analysis at the Massachusetts Department of Public Health. She is an MCH content expert and has co-authored 70 manuscripts on infertility, autism, oral health, racism, opioid and COVID-19.
Article info
Publication history
Published online: November 30, 2022
Accepted:
October 28,
2022
Received in revised form:
October 18,
2022
Received:
February 9,
2022
Publication stage
In Press Corrected ProofFootnotes
The authors declare that they have no conflict of interest.
Supported by the Centers for Disease Control and Prevention Grant #DP006202. The views expressed in this article are those of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention or the Massachusetts Department of Public Health.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
