Results
There was a total of 9,096,788 deliveries documented between 2004 and
2015, inclusive. Out of those, 185 women had a documented diagnosis of
Down syndrome. The prevalence of women with DS varied from 1.48 to 3.14
per 100,000 women during the study period (p-value <.001)
(Figure 1).
The baseline maternal demographic and clinical characteristics of our
study population are summarized in Table 1. Pregnant women with Down
Syndrome, compared with the control group, were more likely to be black
and to smoke or use drugs during the pregnancy (15.4% vs. 5.8%, 7.6%
vs. 3.5% and 4.3% vs. 1.2% respectively). There were no significant
differences between the two groups concerning age, income, or insurance
plan. Patients with Down syndrome did not have a higher prevalence of
pre-existing metabolic conditions including obesity, chronic
hypertension, pregestational diabetes or thyroids disease and were not
more likely to have a multiple gestation compared to the control group.
The association between DS in women and adverse pregnancy and delivery
outcomes, while controlling for confounding variables, are outlined in
Table 2. Women with Down syndrome did not have an increased risk of
developing pregnancy induced hypertension, gestational hypertension,
preeclampsia and gestational diabetes mellitus, compared to the control
group. Down syndrome was not associated with adverse delivery outcomes
including PPROM, chorioamnionitis, operative vaginal delivery, cesarean
delivery, spontaneous vaginal delivery, postpartum hemorrhage, length of
stay and transfusion. Women with Down syndrome were more likely to have
a preterm delivery (aOR 3.86, 95% CI 1.25-11.93).
The association between pregnant women with DS and neonatal outcomes,
while controlling for confounding variables, are outlined in Table 3.
Our results demonstrate staggeringly increased risks of intrauterine
fetal demise (aOR 20.97, 95% CI 1.86-237.02). Neonates born to women
with Down syndrome are overwhelmingly more likely to be small for
gestational age (aOR 13.13, 95% CI 2.20-78.41) and to have congenital
anomalies (aOR 9.59, 95% CI 1.47-62.72).