Women with Hearing Loss Experience Higher Rates of Complications in Pregnancy and Birth
by Dr. Michael Mckee and Dr. Monika Mitra
Reprinted with permission from Hearing Life, the magazine published by the Hearing Loss Association of America. Hearingloss.org, Copyright 2020.
You see the results of a positive pregnancy test and a range of emotions hits you. You are pregnant! For many women, it can be an exciting time and for some, even a scary time. For women who are deaf or hard of hearing, this also becomes an important time to think about ways to have a healthy pregnancy.
A 2016 article in the American Journal of Preventive Medicine raised concerns that women who are deaf or hard of hearing were more likely to experience low birth weight and preterm births. Amid the current increasing focus on addressing maternal and infant health gaps among disadvantaged populations, this was the first time that pregnancy and birth health concerns were identified among women who are deaf or hard of hearing. Additionally, there has been recent research using the Massachusetts Pregnancy to Early Life Longitudinal data system that links birth certificates, fetal death reports and delivery—and non-delivery-related hospital discharge records for all infants and their mothers. This rich dataset, which includes women who gave birth in Massachusetts between January 1998 and December 2013, allowed researchers to deeply probe pregnancy and birth health outcomes for women who are deaf or hard of hearing. When findings were published in 2020, they demonstrated that women who are deaf or hard of hearing were not only at higher risk for adverse birth outcomes, but were also at elevated risk for a variety of health conditions that could impact their pregnancies.
Several health conditions, including diabetes, hypertension, gestational diabetes and preeclampsia or eclampsia, were more com- mon in women who were deaf or hard of hearing than in hearing individuals. Women who were deaf or hard of hearing were also more likely to have cesarean sections and to encounter longer hospital stays after giving birth. This contributes to the growing list of publications demonstrating that individuals who are deaf or hard of hearing struggle with a variety of health disparities, including mental, cognitive and cardiovascular health.
To help us understand why women who are deaf or hard of hearing are more likely to encounter health concerns during pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health awarded a 5-year grant to Monika Mitra, Ph.D., of The Lurie Institute for Disability Policy at Brandeis University’s Heller School for Social Policy and Management and Michael M. McKee, M.D., MPH., associate professor and Lead Director of Disability at the Department of Family Medicine at the University of Michigan, along with their colleagues, to help study the problem.
The results continued to demonstrate that deaf and hard of hearing women were at increased risk of developing chronic diseases and having pregnancy complications, premature delivery and a baby with very low birth weight. It was time to identify what may be driving these health disparities and find ways to intervene. —American Journal of Preventive Medicine
Drs. McKee and Mitra and their research teams set about exploring these drivers by interviewing 67 mothers across the United States who are deaf or hard of hearing with the aim of understanding what may be driving the women’s increased risk for adverse birth outcomes. Many of the mothers described challenges with finding relevant, accessible pregnancy information, as well as significant communication breakdowns in health care settings. “With my [medical] chart being passed around so many times…I don’t know if they knew I had hearing loss or not,” stated one of the participants. Another described being taken for an emergency cesarean section, saying “I didn’t have a clear idea of what was going on. The doctor was not my doctor, and everybody had face masks on, and I…need face masks removed so I can read their lips.” Participants often highlighted the need for health care providers to both identify and understand how to care for women who are deaf or hard of hearing.
Findings from these interviews helped the research team develop a series of questions for the first national survey solely designed for women who are deaf or hard of hearing. Their responses helped the team learn more about the women’s personal and health care system- related pregnancy experiences, unmet needs and barriers and/or facilitators to a healthy pregnancy.
Dr. McKee is a family physician with clinical and research expertise in disability health. As a physician with hearing loss, he is an advocate for the rights of patients to obtain equitable health care, including accessible communication. His research focus includes health disparities for individuals with various disabilities, health information accessibility, health literacy and telemedicine applications. Dr. McKee is on the board of the Association of Medical Professionals with Hearing Losses (AMPHL). He is an appointed member of the Roundtable on Health Literacy of the National Academy of Sciences, Engineering, and Medicine. He is also a member of the Academy Health Disabilities Research Interest Group (IG) Advisory Committee.
Dr. Monika Mitra is the Nancy Lurie Marks Associate Professor of Disability Policy and Director of the Lurie Institute for Disability Policy at Brandeis University. Her research examines the health care experiences and health outcomes of people with disabilities, with a particular focus on sexual and reproductive health of women with disabilities.
According to Dr. Mitra, “The findings from this research will help develop evidence-based policies and practices to guide and improve health care providers who provide perinatal care for women who are deaf or hard of hearing.” Drs. Mitra, McKee and their colleagues intend to develop perinatal care recommendations to provide clinicians with practical tools that address the unique needs of women who are deaf or hard of hearing.
Survey Now Available: If you are a deaf or hard of hearing woman who has given birth in the past ten years, please read more about participating in the survey at: http://sardiprogram.com/DeafPregnancyOutcomes. The survey is both accessible and available in American Sign Language, English and Spanish. Participants who complete the survey will also be entered into a drawing for Amazon gift cards. The survey went live in May. http://sardiprogram.com/DeafPregnancyOutcomes
Survey Results: Press release for the American Journal of Preventive Medicine (AJPM): medicine.umich.edu/ dept/family-medicine/news/archive/202001/new-study-finds-deaf-hard-hearing-women-more-likely-have-pregnancy- complications
Article Citation Link: Mitra M, Mckee MM, Akobirshoev I, et al. Pregnancy, Birth, and Infant Outcomes Among Women Who Are Deaf or Hard of Hearing. American Journal of Preventive Medicine. 2020. doi:10.1016/j. amepre.2019.10.012.
Publication that Prompted the Grant: ajpmonline.org/article/S0749-3797(19)30477-5/fulltext
Hearing life THE MAGAZINE FOR BETTER HEARING A PUBLICATION OF THE HEARING LOSS ASSOCIATION OF AMERICA