Obstetric Care and Pregnancy Health in Autistic Individuals and Those with Other Developmental Disabilities in an Integrated Health Care Setting in California

Background: Early evidence suggests that autistic individuals face unique challenges around pregnancy health, including increased risks of perinatal depression and pregnancy complications such as preterm birth. We aimed to compare pregnancy health and obstetric care utilization among autistic individuals, those with other developmental disabilities (DDs), and those from the general population (GP) in the United States. Methods: In Kaiser Permanente Northern California, we identified all pregnancies that occurred between January 1997 and July 2024 among members with a clinician-documented autism diagnosis ( n = 431) or other DD ( n = 3893). From electronic health records, we extracted data on diagnoses during pregnancy and postpartum, birth outcomes, and obstetric care utilization. We matched pregnancies among the GP 100:1 ( n = 43,100) on birth year and singleton/multiple status to the autistic group. We used adjusted logistic regression to compare outcomes and utilization between the three groups. Results: Compared with the GP, the autistic and DD groups had higher rates of hyperemesis gravidarum (6.1% and 3.3% vs. 1.9%), prenatal depression (52.8% and 27.7% vs. 15.6%), and preterm birth (11.2% and 14.2% vs. 7.5%). Additionally, the autistic group had a higher rate of therapeutic abortion, whereas the DD group had higher rates of pregnancy-related hypertensive disorders than the GP. We did not see disparities in the use of standard prenatal care. However, both the autistic and other DD groups were more likely than the GP to visit the emergency department during pregnancy and postpartum and deliver via cesarean section. Furthermore, the DD group was less likely than the GP to have a postpartum visit. Conclusions: These findings emphasize the importance of addressing the unique obstetric needs of individuals with autism and other DDs, including facilitating access to family planning services, enhancing the quality of prenatal and postpartum care, and providing adequate perinatal mental health support.