Race, ethnicity, and nativity differences in pregnancy and birth outcomes among Medicaid-enrolled women with disabilities

BACKGROUND: Women with disabilities have worse maternal health outcomes than women without disabilities, but we have a limited understanding of other disparities they face. OBJECTIVE: Investigate whether differences in pregnancy and birth outcomes vary by race, ethnicity, and nativity among low-income women with disabilities. METHODS: We conducted a retrospective cohort study of 24,631 live births to Medicaid-enrolled women with disabilities in Texas. We used linked administrative claims with birth certificate data to examine outcomes, including cesarean delivery, severe maternal morbidity (SMM), preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA). Modified Poisson regression estimated relative risks (RRs) for associations by race, ethnicity, and nativity. RESULTS: Non-Hispanic Black women with disabilities had significantly higher risks compared to non-Hispanic White women for SMM (RR 1.54; 95% CI: 1.25-1.90), PTB (RR 1.21; 95% CI: 1.09-1.34), LBW (RR 1.53; 95% CI: 1.37-1.71), and SGA (RR 1.94; 95% CI: 1.67-2.27). Hispanic women overall did not differ significantly from White women. Foreign-born Hispanic women had lower risks for PTB (RR 0.76; 95% CI: 0.64-0.89), LBW (RR 0.68; 95% CI: 0.56-0.82), and SGA (RR 0.76; 95% CI: 0.59-0.99) than US-born Hispanic women, and were less likely to undergo cesarean delivery (RR 0.89; 95% CI: 0.82-0.96). CONCLUSION: Findings highlight racial disparities in adverse maternal outcomes among women with disabilities and reveal important nativity-based differences within the Hispanic population. These results suggest the need for tailored pregnancy care interventions that address disability status alongside intersecting factors of race, ethnicity, and acculturation.