Maternal Disability and Childhood Outcomes: Considerations for the Pediatrician

Maternal disability is a well-known risk factor for poor outcomes in children.^1–3  In this issue of Pediatrics, Brown et al provide a comprehensive analysis of the association of maternal disability with outcomes in childhood up to 24 months of age.⁴  The analysis was based on nearly 108 000 mothers with disabilities and their newborns studied over the course of 7 years in Ontario, Canada. The authors compared these mother–child dyads to >700 000 mother–child dyads with no known maternal disability. The primary outcomes were receipt of the recommended number of well-child visits and routine immunization in the first 2 years of life. Secondary outcomes included receipt of an enhanced 18-month developmental assessment or any developmental screen.

Although the receipt of well-child care, immunizations, and developmental screening was suboptimal for all children, children whose mothers had intellectual/developmental disability (IDD) had the lowest rates. Brown et al found that mothers with IDD were more likely to be younger, have lower incomes, have higher mental health needs, and have children with more complications at birth such as being preterm, having congenital anomalies, or being medically complex. These children were also more likely to have child protective services involvement at the time of newborn nursery discharge.

The study by Brown et al has direct implications for the way we should provide care. As pediatricians, we need to recognize the importance of maternal IDD and screen for this as part of routine child health care. Once identified, we need to ensure full medical home services for the child. One solution is for medical homes to offer care coordination with community health workers, social workers, nurse home visit programs, or care managers for those children whose mothers have IDD.⁵  Through these supports, the medical home can also connect families to any needed resources such as clinic transportation to scheduled visits and appointment reminders.

A second consideration is that we should strongly consider referrals for early intervention for all children of mothers with IDD. Ensuring comprehensive evaluations early on will help identify these at-risk children and support that they reach maximum development. Finally, more studies are needed to best understand questions not addressed in this study such as the role of fathers with IDD in childhood outcomes and the role that child protection services may play to help these children, as well.

IDD

intellectual/developmental disability