(763) Obstetric Care and Pregnancy Health among Autistic Individuals in an Integrated Healthcare Setting in California

Early evidence, mainly from European samples, suggests that individuals with autism spectrum disorder (ASD) face unique challenges around reproductive health, including increased risks of perinatal depression and pregnancy complications. Autistic people also commonly report traumatic experiences in healthcare, particularly in obstetric care.  Our study aimed to describe pregnancy health and obstetric care utilization in autistic individuals in the United States.

Study Design:

Among members of Kaiser Permanente Northern California (KPNC) who had a clinician-documented ASD diagnosis, we identified all pregnancies that occurred between January 1997 and July 2022 (n=235). From electronic health records, we extracted data on sociodemographic factors, diagnoses during pregnancy and postpartum, birth outcomes, and obstetric care utilization. We matched pregnancies among non-autistic members 100:1 on birth year to the autistic group (n=235,000).  We used adjusted logistic regression to compare outcomes and utilization between the two groups.

Results:

Autistic individuals were more likely than non-autistic peers to be younger at pregnancy onset (average age 26 vs. 30 years old), White, non-Hispanic (58% vs. 35%), and to have government-subsidized insurance (25% vs. 10%). Autistic individuals also had higher rates of therapeutic abortion (27% vs. 15%), depression during pregnancy (54% vs. 14%) and postpartum (20% vs. 9%), and pre-term birth (13% vs. 6%).  Pregnancy conditions such as gestational diabetes and pre-eclampsia, and prenatal care utilization, such as timing of prenatal care initiation, screenings, and C-section, did not significantly differ between the groups. However, autistic individuals were more likely to visit the emergency department within 6 months postpartum (Adjusted-OR: 1.56, 95% CI: 1.00, 2.46).

Conclusion:

These findings emphasize the importance of addressing the obstetric needs of autistic individuals, including improving access to family planning services, enhancing the quality of prenatal and postpartum care, and providing adequate perinatal mental health support.