Maternal morbidity and cumulative infant mortality among women with disabilities: a nationwide population-based study in Korea, 2013-2022.

Abstract

Objective: This nationwide population-based descriptive study examined differences in fertility trends, infant mortality, and maternal morbidity between women with and without disabilities in Korea using linked National Health Insurance Service (NHIS) data from 2013 to 2022.

Methods: The study included women of reproductive age (15-49 years) with live births, identified through NHIS eligibility files, claims data, mortality records, and the maternal-neonatal linked database. Disability status was categorized as physical, internal, or mental. Annual birth trends, cumulative mortality among live-born infants at 1 and 5 years, and maternal morbidity during the antepartum, intrapartum, and postpartum periods were compared between women with and without disabilities.

Results: Among 2,861,120 mothers, births among women with disabilities declined more steeply than those among women without disabilities, accompanied by a shift in peak fertility from ages 30-34 to 35-39 years. Infants born to women with disabilities experienced consistently higher cumulative mortality throughout follow-up, with disparities widening over time. Across all perinatal periods, women with disabilities had lower overall maternal morbidity than women without disabilities, with morbidity occurring more frequently during pregnancy and delivery than during the postpartum period in both groups.

Conclusion: These findings highlight important differences in reproductive patterns and infant health outcomes that warrant comprehensive, disability-informed maternal care spanning the antepartum period through enhanced postpartum recovery services. Further research linking administrative data with clinical and social datasets is needed to characterize the morbidity burden more accurately and identify modifiable gaps in care.