Pregnancy outcomes of women with physical disabilities: a matched cohort study.

OBJECTIVE: To document pregnancy outcomes of women with moderate-to-severe physical disabilities and to evaluate maternal and fetal outcomes compared with those of nondisabled 1:1 matched controls within the same hospital system. DESIGN: A retrospective matched cohort. SETTING: A multidisciplinary outpatient reproductive health care clinic for women with physical disabilities, situated in an urban rehabilitation hospital and affiliated with a large tertiary medical care center. POPULATION: Women with physical disabilities. METHODS: A chart review of 755 women with physical disabilities who were seen at a multidisciplinary specialty reproductive health care clinic, in which 48 total pregnancies of 34 women with physical disabilities were found. Thirty-four of these pregnancies were carried to delivery in 25 of these women with physical disabilities. MAIN OUTCOME MEASURES: Obstetric and disability-related pregnancy and delivery complications. RESULTS: Twenty-nine of the 34 pregnancies (85%) occurred in women with moderate-to-severe neurologic disabilities who were wheelchair users, with 33 resultant infants (1 twin pregnancy), and 2 instances of intrauterine fetal demise. Forty percent of the women delivered prematurely, although only 3 of 34 delivered before 32 weeks (9%). Thirty-four percent of the infants (12) were of low birthweight, all of whom were preterm. Although there was a higher rate of pregnancy-related complications (P = .003) in the disabled cohort, there were no maternal deaths, and few of the complications were severe or life threatening. Rates of urinary tract infections and other maternal infections were significantly higher in the disabled cohort and were correlated with both increased preterm delivery and lower birthweight infants (P = .009 and 0.023, respectively). Thirty-eight percent of the infants were delivered by cesarean section. The disabled cohort had lower rates of augmentation of labor (P = .03) and breastfeeding (P = .02) compared with nondisabled controls. Although bladder and functional status changes were noted during the pregnancies of women with physical disabilities, these women reverted to their prepregnancy functional status by 6 weeks postpartum. CONCLUSION: Our study describes a cohort of women who had moderate-to-severe physical disabilities who historically have been discouraged from pregnancy. Women with physical disabilities experienced higher rates of preterm deliveries, low birthweight infants, and pregnancy complications. The pregnancy complications in most cases were not severe and were readily managed. Although it was common to experience functional changes during pregnancy, these changes had largely resolved by 6 weeks postpartum. Larger observational studies are needed to better understand the etiology and prevention of preterm labor and low-birthweight infants in this population, and, in particular, the role of maternal infections.

Future challenges to protecting public health from drinking-water contaminants.

Over the past several decades, human health protection for chemical contaminants in drinking water has been accomplished by development of chemical-specific standards. This approach alone is not feasible to address current issues of the occurrence of multiple contaminants in drinking water, some of which have little health effects information, and water scarcity. In this article, we describe the current chemical-specific paradigm for regulating chemicals in drinking water and discuss some potential additional approaches currently being explored to focus more on sustaining quality water for specific purposes. Also discussed are strategies being explored by the federal government to screen more efficiently the toxicity of large numbers of chemicals to prioritize further intensive testing. Water reuse and water treatment are described as sustainable measures for managing water resources for potable uses as well as other uses such as irrigation.