Study finds youth with developmental disabilities less likely to access reproductive health care

Obstetrician-gynecologist visits and hormonal contraceptive use are less common among adolescents with autism and other developmental disabilities (DDs) than typically developing adolescents, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Takeaways

Adolescents with autism and other developmental disabilities (DDs) visit obstetrician-gynecologists and use hormonal contraceptives less frequently than their typically developing peers.
Pediatric patients with DDs may face higher risks of reproductive health issues due to suboptimal health care, including menstrual irregularities and sexual victimization.
The study involved individuals aged 18 and older, assigned female at birth, and enrolled in Kaiser Permanente Northern California from 2017 to 2019, including those with autism, other DDs, and typically developing individuals.
Only 28.4% of adolescents with autism and 27.9% with other DDs visited an obstetrician-gynecologist during adolescence, compared to 39.1% of typically developing adolescents. Hormonal contraception use was also lower among those with autism (34.3%) and other DDs (32.2%) compared to typically developing peers (43.8%).
The study concluded that reproductive health services for adolescents with autism and other DDs should be enhanced to address the gaps in care and improve overall health outcomes for this population.

Access to reproductive and sexual health care is often limited among adults with DD, but there is little information about access to contraception and obstetrics-gynecology care among adolescent individuals with DD. However, pediatric patients with DD may be at increased risk of reproductive health issues because of suboptimal health care.

According to the Centers for Disease Control and Prevention, autism is characterized by differences in the brain often leading to difficulty with social communication and interaction, as well as restricted or repetitive behaviors.² Delayed language, movement, and cognitive or learning skills may also occur in individuals with autism.

Adverse events more common in youth with DD include menstrual irregularities, pain and distress cycling with menstruation, and sexual victimization and abuse.¹ Clinical guidelines for managing adolescents with DD are available, but these guidelines are limited because of a lack of provider knowledge and available research.

Investigators conducted a study to determine gaps in reproductive health care among adolescents with DD. Participants included individuals aged 18 years and older assigned female at birth and enrolled in the Kaiser Permanente Northern California (KPNC) from 2017 to 2019.

Cohorts included patients with autism, those with another DD, and those with typical development. Autism was determined by a diagnosis of autism spectrum disorder in the KPNC electronic health record system 2 or more times before the end of 2019. Other DDs included cerebral palsy, intellectual disability, and Down syndrome.

Typically developing patients were matched 4:1 to those in the autism group based on age. Diagnoses of menstrual disorders, polycystic ovary syndrome (PCOS), premenstrual syndrome, urinary tract infections (UTIs), and laboratory results for sexually transmitted infection (STI) tests when patients were aged 14 to 18 years were reported.

Health care use variables included outpatient visits to obstetrics-gynecology and primary care, hormonal contraception use, hormonal contraception prescription by a provider, and STI screening. Short-acting reversible hormonal contraception was evaluated as well as long-acting reversible contraception. Covariates include race and ethnicity, insurance payer, and cumulative months of KP membership.

Adolescents in the autism group were more often non-Hispanic White than those in the DD or typically developing groups. At least 1 pediatric primary care visit when aged 14 to 18 years was reported by approximately 97% of patients in each study group, and at least 5 visits by approximately 75%.

Menstrual disorder diagnoses were reported in 32.2% of the typically developing group, 38.1% of the autism group, and 39.7% of the DD group. PCOS rates were 10.6%, 17%, and 15.8%, respectively, and premenstrual syndrome rates were 1.6%, 5.4%, and 2.8%, respectively.

UTIs and STIs were more common in the typically developing group vs the autism and DD groups, at 15%, 6.7%, and 10.5%, respectively for UTIs and 3.1% vs under 1% and under 1%, respectively. A PCOS diagnosis was more common in patients with autism than another DD, with an adjusted relative risk of 1.28.

The odds of visiting an obstetrician-gynecologist during adolescence was 39.1% among typically developing patients, vs 28.4% among those with autism and 27.9% with DD. However, the odds of using obstetrics-gynecology care by age 14 years was more common among patients with autism or another DD with a reported visit during adolescence.

Hormonal contraception use was also significantly reduced among the autistic and DD groups vs the typically developing group, at 34.3%, 32.2%, and 43.8%, respectively. The use of 1 or more contraception among patients with hormonal contraception use was approximately 25% in all groups.

These results indicated decreased odds of an obstetrician-gynecologists visit or hormonal contraceptive use among adolescents with autism or another DD vs those with typical development. Investigators concluded health care should be improved among this population by assessing reproductive health services.