Physical disability and venous thromboembolism during pregnancy and the postpartum period: a population-based cohort study

Severe Maternal Morbidity and Other Perinatal Complications Among Black, Hispanic, and White Birthing Persons With and Without Physical Disabilities

Background: People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. Methods: We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. Results: Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. Conclusions: Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.

An evaluation of conceptual frameworks to improve reproductive health outcomes among women with physical disabilities

AIM(S)

To identify and evaluate conceptual frameworks intended to guide reproductive health research among women with physical disabilities.

DESIGN

Discussion paper.

METHODS

We identified and evaluated frameworks related to the reproductive health of women with physical disabilities using modified criteria by Fawcett and DeSanto-Madeya with constructs from the International Classification of Functioning, Disability, and Health.

DATA SOURCES

We conducted a systematic review of literature published from 2001 to 2024 in four databases.

RESULTS

Our review revealed two frameworks: (1) A perinatal health framework for women with physical disabilities is applicable to studies that consider multiple socioecological determinants in pregnancy; (2) A conceptual framework of reproductive health in the context of physical disabilities can guide the development of patient-reported outcome measures for a range of reproductive health outcomes.

CONCLUSION

The identified frameworks have high potential to guide studies that can improve the reproductive health of women with physical disabilities. However, they have low social congruence among racially and ethnically minoritized women.

IMPLICATIONS FOR NURSING

Future frameworks must take an intersectional approach and consider the compounding injustices of ableism, racism, classism and ageism on reproductive health. A holistic approach that is inherent to the discipline of nursing is essential to address these knowledge gaps.

IMPACT

The reproductive health of women with disabilities is a research priority. Nurses and other researchers can select the framework most applicable to their research questions to guide study designs and should incorporate multi-level determinants to eliminate reproductive health disparities.

Diagnostic strategies in postpartum individuals with suspected venous thromboembolism: A scoping review

BACKGROUND

The risk of venous thromboembolism (VTE) is increased postpartum and contributes to important morbidity and mortality. While there have been advances in evaluating diagnostic algorithms for suspected VTE during pregnancy, there is limited data for postpartum individuals.

OBJECTIVE

We conducted a scoping review to describe and evaluate diagnostic strategies used to investigate suspected VTE in postpartum individuals.

METHODS

A comprehensive search strategy was conducted in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (January 1, 2000-September 30, 2022) to identify original articles that reported on diagnostic strategies in postpartum individuals with suspected VTE. We extracted demographics, clinical decision rules used, D-dimer and imaging completed, including test performance and VTE outcomes.

RESULTS

A total of 13 studies conducted across 11 countries with separate postpartum data were included for 759 individuals with suspected PE (n = 634) or DVT (n = 125), including unpublished data (n = 251). Among those with suspected PE, computed tomography pulmonary angiography was conducted more commonly (n = 522) than ventilation-perfusion scans (n = 69), with PE positivity rates that ranged from 4 %-27.6 % and 0-50 % across studies, respectively. Among 131 postpartum individuals with suspected PE who had a D-dimer measured, only 4.6 % (6/131) had a negative D-dimer test. For postpartum individuals with suspected DVT, the most common diagnostic test was compression ultrasonography (positivity rate 12.2 %-18.6 %). There were limited retrospective data evaluating the clinical decision rules.

CONCLUSIONS

There are heterogeneous approaches globally in the diagnosis of suspected postpartum VTE. Limited high-quality data available underscores the need for more robust evidence to inform clinical practice.