Date of Award

January 2026

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Valery Danilack-Fekete

Abstract

Background: Disability affects approximately 10-12% of reproductive-aged women in the United States, yet maternal health outcomes among this population remain understudied. Prior research suggests an increased risk of adverse outcomes among women with disabilities, though many studies rely on administrative data that may underestimate disability prevalence.Objective: This study examined the association between disability and adverse maternal and infant outcomes using PRAMS data from Missouri and Oregon between 2019 and 2020. Methods: Disability was measured using the Washington Group Short Set. Adverse outcomes were defined as a composite of maternal complications and infant outcomes. Logistic regression models estimated unadjusted and adjusted associations, controlling for selected covariates. Results: Disability prevalence ranged from 7.4 to 8.9%, while adverse outcomes occurred in approximately 35-41% of pregnancies. Disability was crudely associated with increased odds of adverse outcomes, though this was not statistically significant after adjustment (OR = 0.89, 95% CI: 0.62-1.26). Smoking during pregnancy (OR =1.74, 95% CI: 1.36-2.24), chronic conditions (OR for ≥2 chronic conditions = 2.53, 95% CI: 1.86-3.43), marital status (OR = 1.41, 95% CI: 1.22-1.64), and maternal BMI (OR = 1.05, 95% CI: 1.04-1.06) were associated with increased odds of adverse outcomes, while higher maternal and paternal education were protective. Conclusion: Disability was not significantly associated with adverse outcomes after adjustment. This may reflect confounding by clinical risk factors, missing disability data - particularly in Oregon 2019 - and the use of a broad composite outcome. Improved measurement and more targeted outcome definitions are needed better to understand maternal health disparities among individuals with disabilities.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 03/16/2027

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