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Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study
  1. Monika Mitra1,
  2. Ilhom Akobirshoev1,
  3. Susan L Parish2,
  4. Anne Valentine1,
  5. Karen M Clements3,
  6. Tiffany A Moore Simas4
  1. 1 Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
  2. 2 Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
  3. 3 The Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4 Department of Obstetrics and Gynecology, UMass Memorial Health Care; Departments of Obstetrics and Gynecology, Pediatrics, and Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Dr Monika Mitra, Lurie Institute for Disability Policy, Brandeis University, Waltham 02453, Massachusetts, USA; mmitra{at}


Background An emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.

Methods We analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.

Results We identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.

Conclusion These findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.

  • disability
  • health services
  • maternal health
  • pregnancy

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  • Contributors MM took the lead in writing the manuscript. IA conducted the analyses. All authors discussed the results, provided critical feedback, helped shape the research and analysis, and contributed to the final manuscript.

  • Funding Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number R01HD082105. Research reported in this publication was also supported by the National Institute on Disability, Independent Living, and Rehabilitation Research under Award Number 90DPGE0001.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Brandeis University institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.