Postpartum hospital readmissions among women with intellectual and developmental disabilities

Postpartum hospital readmission is an indicator of significant maternal morbidity. Women with intellectual and developmental disabilities (IDD) may be particularly vulnerable to poor medical and psychiatric outcomes during the postpartum period; however, this has not been previously examined. Our objective was to compare the risks of postpartum medical and psychiatric hospital readmissions among women with and without IDD. We conducted a population-based cohort study using Ontario (Canada) health and social services administrative data. We identified singleton live births to women with (N=3,869) and without (N=380,680) IDD (2002-2011 fiscal years). We used modified Poisson regression to estimate the risks of postpartum hospital readmission (total, medical, psychiatric) within 12 weeks of delivery discharge. We also examined readmissions within 7 days and between 8 days and 12 weeks. Multivariable models controlled for baseline social and health characteristics, including pre-existing mental health issues. Women with IDD were at increased risk for postpartum hospital readmission within 12 weeks (10.9% vs. 2.1%; aRR=3.41, 95% CI 3.13-3.94), including psychiatric (9.6% vs. 1.0%) but not medical (1.6% vs. 1.1%) readmissions. They were at increased risk for readmission both within 7 days (10.1% vs. 1.5%; aRR=4.24, 95% CI 3.74-4.80) and between 8 days and 12 weeks (1.6% vs. 0.7%; aRR=1.77, 95% CI 1.36-2.31). In both time periods, risks were driven by psychiatric readmissions. The high rates of postpartum hospital readmission among women with IDD, particularly for psychiatric reasons, show that there is an urgent need for enhanced supports for women with IDD during the postpartum period.