(570) Birth Morbidity and Readmissions in Autistic People and People With Intellectual and Developmental Disabilities

Emerging research suggests people with intellectual and developmental disabilities (IDD) have fertility rates similar to the general population. However, studies have highlighted riskier delivery outcomes, including premature delivery and cesarean section, in this group. The objective of this study was to establish prevalence of adverse delivery outcomes, including hospital readmission, in people with autism, other IDDs, and without autism or IDD.

Study Design:

We used the National Readmission Database (NRD), an all-payer collection of inpatient hospital records, from 2019 and 2020 to examine deliveries. NRD (from the Healthcare Cost and Utilization Project) is sampled from 97% of all hospital discharges in the U.S. We compared people with autism, other IDD, and all other deliveries along antepartum (gestational diabetes), intrapartum (mode of delivery (vaginal, assisted vaginal, cesarean), hemorrhage, preeclampsia and eclampsia), and postpartum (prolonged hospital stay during delivery, readmission within 7 and 30 days of discharge) outcomes. We also examined patient characteristics including Medicaid insurance.

Results:

Some outcomes were more common in people with autism and IDD, including preeclampsia (12% autism, 14% IDD, 7% other), instrumental delivery (39% autism, 47% IDD, 36% other), and stays longer than 5 days (7% autism, 9% IDD, 3% other). All-cause readmission within 30 days was also more common (3% autism, 6% IDD, 1% other). There was no difference in rate of cesarean section. Medicaid coverage was common in autistic people (59%) and people with IDD (52%), compared to 41% of other deliveries.

Conclusion:

This study highlights disparities in delivery outcomes of a demographic that is largely missing from pregnancy care and research. These disparities are likely further exacerbated by other social determinants of health, including race and ethnicity. Individual and structural factors including patient, clinician, and health system factors are all at play and need to be examined to better understand and adapt care delivery to this population.