Biological factors and/or the mothers’ social-environmental situation may be responsible for the much higher relative risk for pregnant intellectually disabled women and their newborns reported in articles by Höglund et al. in this issue. This population has increased exposure to key social determinants of health such as poverty and social exclusion. This is compounded by institutional discriminatory beliefs and practices. People with intellectual disability may also struggle to communicate their needs effectively and to be heard and understood by health professionals. Further research is warranted to understand the reasons for two stand-out findings: why rates of stillbirth and perinatal death are significantly higher in this group and whether varying obstetric practices are responsible for the significantly lower use of pain relief during childbirth. Quality health care requires that due attention is given to meeting the specific needs of this vulnerable group of mothers and their newborns.