Corresponding author: Shunji Suzuki, czg83542@mopera.ne.jp
DOI: 10.31662/jmaj.2021-0005
Received: January 12, 2021
Accepted: February 1, 2021
Advance Publication: March 18, 2021
Published: April 15, 2021
Cite this article as:
Suzuki S. Cases of Pregnancy with Mild Intellectual Disabilities Managed at a Japanese Perinatal Center. JMA J. 2021;4(2):166-168.
Key words: mild intellectual disabilities, pregnancy, multidisciplinary collaboration, Japan
Intellectual disability (ID) is a generalized neurodevelopmental disorder characterized by impaired intellectual and adaptive functioning (1), (2), (3). Mild ID has been defined by an intelligence quotient (IQ) of 50-69 in addition to deficits in two or more adaptive behaviors that affect general living.
During pregnancy and childcare, women need to learn and practice a variety of new things; however, those with ID have difficulties in learning or practice. Thus, medical staffs have to care and support them in considering with the difficulties by multidisciplinary collaboration. In Japan, there have been various reports from the staff of local government agencies and nursing that summarized the care (4), (5), (6), (7), (8), but only a few reports from obstetricians.
Therefore, in this study, we reviewed the obstetric records to examine the clinical characteristics and perinatal outcomes of 12 Japanese pregnant women who had been issued the Rehabilitation Handbook (= certification) for mild ID and who delivered at our institute after 22 weeks of gestation between 2017 and 2020. The protocol for this study was approved by the Ethics Committee of the Japanese Red Cross Katsushika Maternity Hospital. Their comprehension in conversation was evaluated based on the impression of our trained midwives. In our institute, the Japanese version of Mother-to-Infant Bonding Scale (MIBS-J) (9) has been used to detect problems in a mother's feelings toward her baby at one month after delivery. In the MIBS-J, the mother is evaluated as having a mother-infant bonding if the score is 2 or less.
As shown in Table 1, the pregnant women with mild ID sometimes suffered from other mental disorders, including depression from various stresses in their lives. Because their partners also often have similar levels of ID and/or other mental disorders, a lot of social and medical support will be required in their pregnancies and/or childcare. They seemed to have enough love for their children; however, it was hard to make them feel the responsibility in and difficulty of childcare. After discharge, they all went home with their children, and there was appropriate childcare observed in them.
Table 1. Clinical Characteristics and Perinatal Outcomes of 12 Japanese Pregnant Women with Mild Intellectual Disabilities.
| Yes | ||
|---|---|---|
| Number | % | |
| Total number | 12 | 100 |
| Maternal age | ||
| <25 years | 9 | 75 |
| ≥25 years | 3 | 25 |
| Multiparous woman | 2 | 17 |
| Psychiatric diseases with intellectual disabilities | 5 | 42 |
| Absence of partner | 2 | 17 |
| Partner having mental disorders | 8 (/10) | 80 |
| Comprehension | ||
| Easy reading, writing, and calculation | 9 | 75 |
| Easy understanding general conversation | 2 | 17 |
| Easy compliance of health guidance | 1 | 8 |
| Easy compliance of medical explanations | 1 | 8 |
| Serious fear against treatment and/or delivery | 2 | 17 |
| Image of postpartum life during pregnancy | 8 | 67 |
| Perinatal complications | ||
| Hypertensive disorders | 4 | 33 |
| Impaired glucose tolerance | 1 | 8 |
| Fetal growth restriction | 0 | 0 |
| Obstetric outcomes | ||
| Preterm delivery | 2 | 17 |
| Cesarean delivery | 8 | 67 |
| NICU admission | 2 | 17 |
| Healthy discharge of both mother and child | 12 | 100 |
| Maternal-child bonding at 1 month after delivery | 11 | 92 |
| Inappropriate childcare | 0 | 0 |
| NICU, neonatal intensive care unit. | ||
We understand the small sample size of the current study; however, the incidence of hypertensive disorders during pregnancy in women with mild ID seemed to be high (33% vs. almost 10%: average incidence in Japan (10)), which are supported by some recent reports (11), (12). The reasons for the increased hypertension among pregnant women with ID have been unclear; however, Brown et al. (11) suggested that there is a need to address modifiable risk factors for adverse outcomes among women with ID prior to and during pregnancy. On the basis of the current results, the fear against treatment and/or delivery in them may be associated with the development of sympathetic-stimulated hypertension. In any cases, a further large study is needed with consideration that wellness during pregnancy involves social, familial, and clinical support systems responsive to each woman's needs.
As expected, the pregnant women with mild ID had poor understanding of medical explanations; however, they were able to be brought up by patiently explaining and practicing in cooperation with local government agencies (1), (2), (3), (4). They thought that their children are cute and showed affection; however, they seemed to be poor at dealing with things that they were not interested in or difficult. In particular, breastfeeding at night was seemed to be difficult to learn based on our impression as previously reported (8). On the basis of the results of the MIBS-J, there was one mother with a possibility that she had problems regarding feelings for her baby; however, her mother-child bonding seemed to be formed with the child-rearing support by the public health nurses/midwives, although she seemed confused regarding her child-rearing life for one month after delivery. In this study, all mothers with mild ID could perform appropriate childcare with the support of those around them.
In addition, Nagai (8) was concerned that women with ID tend to refuse social supports during pregnancy and childcare. However, compared to those with other mental disorders such as schizophrenia spectrum disorders (13), (14), if they become aware of childcare difficulties as the result of time-consuming practice, their subsequent acceptance of social support will be smooth.
Although the subjects in this study were limited to women with mild ID, various supports seemed to be required and performed for them. However, one of the serious limitations of the examination may be that we examined only cases with mild ID. This is because those with moderate or higher ID (IQ of <50) often encounter inability in childcare less than 1 week after delivery (4), (8). Pregnant women with moderate or higher ID also seemed to love their children, although they might more likely experience maltreatment than those with no or mild disabilities (15); however, they usually cannot envision postpartum life with childcare, so medical staff have to fully evaluate and predict their childcare abilities by multidisciplinary collaboration (16). If their childcare abilities are not sufficient, support of the social care facilities such as infant care centers should be provided.
In conclusion, we reported cases of pregnancy with mild ID supported by multidisciplinary collaboration at a Japanese perinatal center.
None
Shunji Suzuki: all project development, data management, data analysis, manuscript writing/editing.
The study protocol was approved by the Ethics Committee of the Japanese Red Cross Katsushika Maternity Hospital (K2020-16).
Patients’ informed consent for publication of this report was obtained.
APA (American Psychiatric Association). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: APA; 2013.
AAIDD (American Association on Intellectual Developmental Disabilities). Intellectual disability: Definition, classification, and systems of supports. Washington, DC: AAIDD; 2010.
Shogren KA, Turnbull HR. Public policy and outcomes for persons with intellectual disability: extending and expanding the public policy framework of AAIDD's 11th Edition of Intellectual Disability: Definition, Classification, and Systems of Support. Intellect Dev Disabil. 2010;48(5):375-86.
Sugiura K, Fujisawa K. Handbook on dealing with pregnant women with intellectual disabilities [Internet]. [cited 2021 Jan 12]. Available from: http://zen-iku.jp/wp-content/uploads/2020/12/201228handbook.pdf. Japanese.
Oki Y, Kawahara J, Sugiura K. Consideration on support for pregnancy, childbirth, and childcare of women with intellectual disabilities. Okayama Maternal Health. 2018;34:17-8. Japanese.
Terakawa S, Mizoguchi Y, Inagaki M, et al. Problems about child caring in mental retarded mothers. Pediatric Health Research. 2005;64(2):301-7. Japanese.
Sugimoto A, Suemitsu S. Literature review of the research on the support systems for families with intellectual disabilities on the difficulties on marriage and parenting. Kawasaki Med Welf J. 2018;27(2):491-4. Japanese.
Nagai H. The attitude and capability of child raising during an early postnatal period and afterward in mothers with mental deficiency or psychosis. Pediatr Health Res. 2012;71(4):591-5. Japanese.
Yoshida K, Yamashita H, Conroy S, et al. A Japanese version of Mother-to-Infant Bonding Scale: factor structure, longitudinal changes and links with maternal mood during the early postnatal period in Japanese mothers. Arch Womens Ment Health. 2012;15(5):343-52.
Mayama M, Morikawa M, Umazume T, et al. Increase in the number of patients diagnosed using the new classification of hypertensive disorders of pregnancy in Japan. J Obstet Gynaecol Res. 2019;45(6):1118-26.
Mueller BA, Crane D, Doody DR, et al. Pregnancy course, infant outcomes, rehospitalization, and mortality among women with intellectual disability. Disabil Health J. 2019;12(3):452-9.
Brown HK, Cobigo V, Lunsky Y, et al. Maternal and offspring outcomes in women with intellectual and developmental disabilities: a population-based cohort study. BJOG. 2017;124(5):757-65.
Suzuki S, Takeda S, Okano T, et al. Recent strategies in perinatal mental health care in Japan. Hypertens Res Preg. 2018;6(1):11-4.
JAOG (Japan Association of Obstetricians and Gynecologists). Mental health care manual for pregnant women [Internet]. Tokyo: JAOG; 2017 [cited 2021 Jan 12]. Available from: http://www.jaog.or.jp/wp/wp-content/uploads/2017/11/jaogmental_L.pdf. Japanese.
Horner-Johnson W, Drum CE. Prevalence of maltreatment of people with intellectual disabilities: a review of recently published research. Ment Retard Dev Disabil Res Rev. 2006;12(1):57-69.
University of Hertfordshire. Intellectual disability and health: parents with intellectual disabilities [Internet]. [cited 2021 Jan 12]. Available from: http://www.intellectualdisability.info/family/articles/parents-with-intellectual-disabilities.
Download PDF