Preconception Health and Pregnancy Rates of Autistic Women in Ontario

Background: There is a growing recognition that preconception health, the health of all individuals of reproductive age, impacts reproductive and perinatal outcomes. However, very little is known about the preconception health of autistic women. Similarly, there is an absence of population level data on pregnancies in autistic women, although it is now widely recognized that pregnancies occur and that health supports could be strengthened. The current interest in the health of autistic women should extend to their preconception and reproductive health, so that health care providers can better attend to their unique needs, and support conception and healthy pregnancies for women who wish to become mothers.

Objectives: Our objectives were to first describe the preconception health characteristics of a population-based cohort of autistic women relative to women in the general population and to report on their pregnancy rates.

Methods: We conducted a population-based, cross-sectional study using Ontario health administrative data (2015-2016). We identified 15-44-year-old women with autism (n= 5,426) and women without any developmental, physical, or sensory disabilities (n=2,303,066). Preconception health variables were social (poverty), health (chronic disease, teratogenic medication use, mental illness, history of assault), and health care factors (continuity of care). We described these characteristics using frequencies and percentages and compared autistic women to those without disabilities using standardized differences, wherein differences >0.10 were considered to be clinically meaningful. We also describe the rates of live births, induced abortions and pregnancy losses in both groups.

Results: Compared to women without disabilities, autistic women were equally likely to live in poverty. They were more likely to have asthma and an unstable chronic medical condition although other medical conditions were not more common. They were more likely to have a psychotic mental illness, a mood/anxiety disorder, a substance use disorder, self-harm, or other mental illness and to have experienced assault. They were also more likely to be receiving teratogenic medications (1/3 of autistic women). However, they were more likely to routinely access the same primary care provider, indicating high continuity of care. Pregnancy rates were lower for autistic women than other women with an overall prevalence rate for autistic women of 16.4 per 1000 autistic women compared to 54.0 per 1000 women with no disabilities.

Conclusions: Research on factors contributing to poor preconception health among autistic women is needed, particularly with regard to their mental health, as are tailored interventions to improve preconception health for those women who wish to conceive. It will be important to explore whether lower pregnancy rates are consistent with the reduced desire of this group to become pregnant, or if there are other health or social contributors.