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James TG, McKee KS, Moore Simas TA, Smith LD, McKee MM, Mitra M. Cesarean birth and adverse birth outcomes among sub-populations of deaf and hard-of-hearing people. Disabil Health J 2024:101639. [PMID: 38811248 DOI: 10.1016/j.dhjo.2024.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/24/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) people are at higher risk than their non-DHH counterparts of experiencing adverse birth outcomes. There is a lack of research focusing on social, linguistic, and medical factors related to being DHH which may identify groups of DHH people who experience more inequity. OBJECTIVE Examine difference in prevalence of cesarean and adverse birth outcomes among diverse sub-groups of DHH people. METHODS We conducted a cross-sectional survey of DHH birthing people in the U.S. who gave birth within the past 10 years. The sample was predominantly white, college educated, and married. We assessed cesarean birth and three adverse birth outcomes: preterm birth, low birthweight, and NICU admission post-delivery. DHH-specific variables were genetic etiology of hearing loss, preferred language (i.e., American Sign Language, English, or bilingual), severity of hearing loss, age of onset of hearing loss, and self-reported quality of perinatal care communication. We estimated prevalence, 95 % confidence intervals, and unadjusted prevalence ratios. RESULTS Thirty-one percent of our sample reported a cesarean birth. Overall, there were no significant differences in prevalence across the outcome variables with respect to preferred language, genetic etiology, severity, and age of onset. Poorer perinatal care communication quality was associated with higher prevalence of preterm birth (PR = 2.37) and NICU admission (PR = 1.91). CONCLUSIONS Our study found no evidence supporting differences in obstetric outcomes among DHH birthing people across medical factors related to deafness. Findings support the important role of communication access for DHH people in healthcare environments.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, USA.
| | | | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, MA, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
| | | | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
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McKee MM, Zhang J, Akobirshoev I, McKee K, Mitra M. Antenatal Hospital Use among Deaf and Hard of Hearing Women. Am J Perinatol 2024; 41:e1560-e1569. [PMID: 36918163 DOI: 10.1055/a-2053-7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women. STUDY DESIGN We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N = 925) and hearing (N = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for sociodemographic and clinical characteristics. RESULTS Among DHH women (N = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women (N = 28,95) during the antenatal period (all ps < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p < 0.001) and inpatient stays (RR = 1.89; p < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p-values < 0.001). CONCLUSION The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed. KEY POINTS · Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes..
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jianying Zhang
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Mitra M, Akobirshoev I, Valentine A, McKee K, McKee MM. Severe maternal morbidity in deaf or hard of hearing women in the United States. Prev Med 2024; 180:107883. [PMID: 38307211 DOI: 10.1016/j.ypmed.2024.107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Prior studies on severe maternal morbidity (SMM) have often excluded women who are deaf or hard of hearing (DHH), even though they are at increased risk of pregnancy complications and adverse birth outcomes. This study compared rates of SMM during delivery and postpartum among DHH and non-DHH women. METHODS This nationally representative retrospective cohort study used hospital discharge data from the 2004-2020 Health Care and Cost Utilization Project Nationwide Inpatient Sample. The risk of SMM with and without blood transfusion during delivery and postpartum among DHH and non-DHH women were compared using modified Poisson regression analysis. The study was conducted in the United States in 2022-2023. RESULTS The cohort included 9351 births to DHH women for the study period, and 13,574,382 age-matched and delivery year-matched births to non-DHH women in a 1:3 case-control ratio. The main outcomes were SMM and non-transfusion SMM during delivery and postpartum. Relative risks were sequentially adjusted for sociodemographic characteristics, hospital-level characteristics, and clinical characteristics. In unadjusted analyses, DHH women were at 80% higher risk for SMM (RR = 1.81, 95% CI 1.63-2.02, p < 0.001) during delivery and postpartum compared to non-DHH women. Adjustment for socio-demographic and hospital characteristics attenuated risk for SMM (RR = 1.54, 95% CI 1.38-1.72, p < 0.001). Adjustment for the Elixhauser comorbidity score further attenuated the risk of SMM among DHH women (RR = 1.13, 95% CI 1.01-1.26, p < 0.05). CONCLUSION The findings of this study demonstrate a critical need for inclusive preconception, prenatal, and postpartum care that address conditions that increase the risk for SMM among DHH people.
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Affiliation(s)
- Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St. MS 035, Waltham, MA 02453, USA
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Horner-Johnson W, Akobirshoev I, Valentine A, Powell R, Mitra M. Preconception health risks by presence and type of disability among U.S. women. Disabil Health J 2024:101588. [PMID: 38336500 DOI: 10.1016/j.dhjo.2024.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Poor preconception health may contribute to adverse perinatal outcomes among women with disabilities. While prior research has found higher prevalence of preconception health risks among women with versus without disabilities, existing U.S. studies have not assessed how preconception health risks may differ by disability type. Understanding such differences is relevant for informing and targeting efforts to improve health opportunities and optimize pregnancy outcomes. OBJECTIVE This cross-sectional study examined preconception health in relation to disability type among reproductive-age women in the United States. METHODS We analyzed 2016-2019 data from the Behavioral Risk Factor Surveillance System to estimate the prevalence of 19 preconception health risk among non-pregnant women 18-44 years of age. We used modified Poisson regression to compare women with different types of disability to non-disabled women. Disability categories included: 1) hearing difficulty only; 2) vision difficulty only; 3) physical/mobility difficulty only; 4) cognitive difficulty only; 5) multiple or complex disabilities (including limitations in self-care or independent living activities). Multivariable analyses adjusted for other sociodemographic characteristics such as age and marital status. RESULTS Women with each disability type experienced a higher prevalence of indicators associated with poor preconception health compared to women with no disabilities. The number and extent of health risks varied substantially by disability type. Women with cognitive disabilities and women with multiple or complex disabilities experienced the greatest risk. CONCLUSIONS Addressing the specific preconception health risks experienced by women with different types of disabilities may help reduce adverse perinatal outcomes for disabled women and their infants.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Robyn Powell
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Helm KVT, Panko TL, Herschel M, Smith LD, Mitra M, McKee MM. Maternal Health Experiences of Black Deaf and Hard of Hearing Women in the United States. Womens Health Issues 2023; 33:610-617. [PMID: 37648627 PMCID: PMC10843088 DOI: 10.1016/j.whi.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Deaf and hard of hearing (DHH) women are faced with numerous health inequities, including adverse pregnancy and birth outcomes. These outcomes are likely exacerbated for Black DHH women because of the intersection of disability and race. This study aimed to explore the pregnancy and birth experiences of Black DHH women to identify factors that influence their pregnancy outcomes. METHODS Semistructured interviews were conducted between 2018 and 2019 with 67 DHH women who gave birth in the past five years. The present study represents a subgroup analysis of eight of the 67 women who self-identified as Black. Interviews were recorded, transcribed, and analyzed for emerging themes. RESULTS Primary themes centered on unmet needs, barriers, and facilitators. Barriers included limited access to health information owing to communication difficulties and challenges obtaining accommodations. Key facilitators included the availability of sign language interpreters, familial support, and cultural understanding from providers. Participants emphasized these facilitators in their recommendations to providers and DHH women. Findings also underscored the critical role of recognizing cultural identity in perinatal health care delivery. CONCLUSIONS This study outlines themes that affect pregnancy and birthing experiences among Black DHH women in the United States. Study implications include a call to action for providers to prioritize communication accommodations, accessible information, and compassionate care for all Black DHH women. Furthermore, future work should explore the impact of cultural and racial concordance between patients and their health care providers and staff. Understanding how intersectional identities affect perinatal health care access is crucial for reducing disparities among Black DHH women.
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Affiliation(s)
- Kaila V T Helm
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Tiffany L Panko
- Rochester Institute of Technology, NTID Research Center on Culture and Language, Rochester, New York
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lauren D Smith
- Brandeis University, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Waltham, Massachusetts
| | - Monika Mitra
- Brandeis University, Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Waltham, Massachusetts
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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James TG, Panko T, Smith LD, Helm KVT, Katz GR, Caballero ME, Cooley MM, Mitra M, McKee MM. Healthcare communication access among deaf and hard-of-hearing people during pregnancy. PATIENT EDUCATION AND COUNSELING 2023; 112:107743. [PMID: 37060682 PMCID: PMC10167864 DOI: 10.1016/j.pec.2023.107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Deaf and hard-of-hearing (DHH) people report ineffective healthcare communication. Limited research has been conducted on healthcare communication during pregnancy. This study's aim was to assess communication accommodations and experiences during pregnancy for DHH people. METHODS An accessible web-based survey was administered to a non-probability sample of DHH people through national organizations, social media, and snowball sampling. Eligibility criteria included being 21 years or older; given birth in the U.S. within the past 10 years, report hearing loss prior to the most recent birth. Questions focused on healthcare experiences and information access during their last pregnancy. The sample included 583 respondents for the present analysis. We describe the communication accommodations requested and received during pregnancy, segmented by preferred language. RESULTS Most DHH participants reported communication with prenatal clinicians as "good" or "very good". On-site interpreter services were most commonly requested by American Sign Language (ASL) only and bilingual DHH people. Interpersonal communication modification requests (e.g., speaking louder) were rarely obliged. CONCLUSION This study is the first national examination of requested and received communication accommodations for DHH patients during the perinatal period. PRACTICE IMPLICATIONS Healthcare providers should work closely with patients to ensure effective communication access is provided.
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Affiliation(s)
- Tyler G James
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Tiffany Panko
- Deaf Health Laboratory, Center for Culture and Language, National Technical Institute for the Deaf, Rochester Institute of Technology, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Kaila V T Helm
- Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabrielle R Katz
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Margarita M Cooley
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Panko TL, Cuculick J, Albert S, Smith LD, Cooley MM, Herschel M, Mitra M, McKee M. Experiences of pregnancy and perinatal healthcare access of women who are deaf: a qualitative study. BJOG 2023; 130:514-521. [PMID: 36156842 PMCID: PMC9992236 DOI: 10.1111/1471-0528.17300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Women who are deaf experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared with their peers who can hear. This study explores the pregnancy experiences of women who are deaf to better understand their barriers to and facilitators of optimal pregnancy-related health care. DESIGN Qualitative study using thematic analysis. SETTING Semi-structured, individual, remote or in-person interviews conducted in the USA. SAMPLE Forty-five women who are deaf and communicate using American Sign Language (ASL) and gave birth in the USA within the past 5 years participated in the interviews. METHODS Semi-structured interviews explored how mothers who are deaf experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. MAIN OUTCOME MEASURES Barriers and facilitators related to a positive experience of perinatal care access among women who are deaf. RESULTS Three major themes emerged: (1) communication accessibility; (2) communication satisfaction; and (3) healthcare provider and team support. Common barriers included choosing healthcare providers, inconsistent communication access and difficulty accessing health information. However, when women who are deaf were able to use ASL interpreters, they had more positive pregnancy and birth experiences. Self-advocacy served as a common facilitator for more positive pregnancy and healthcare experiences. CONCLUSIONS Healthcare providers need to be more aware of the communication and support needs of their patients who are deaf, especially how to communicate effectively. Increased cultural awareness and consistent provision of on-site interpreters can improve pregnancy and birth experiences for women who are deaf.
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Affiliation(s)
- Tiffany L Panko
- NTID Research Center on Culture and Language, Rochester Institute of Technology, Rochester, New York, USA
| | - Jess Cuculick
- NTID Department of Liberal Studies, Rochester Institute of Technology, Rochester, New York, USA
| | - Sasha Albert
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Lauren D Smith
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Margarita M Cooley
- Independent Consultant to Brandeis University, Waltham, Massachusetts, USA
| | - Melanie Herschel
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Tang MB, Kung PT, Chiu LT, Tsai WC. Comparison of the use of prenatal care services and the risk of preterm birth between pregnant women with disabilities and those without disabilities: A nationwide cohort study. Front Public Health 2023; 11:1090051. [PMID: 36778582 PMCID: PMC9911428 DOI: 10.3389/fpubh.2023.1090051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The difficulties faced by pregnant women with disabilities in accessing health care may make them less likely to receive prenatal care. The aims of this study were to compare the number of prenatal services and the risk of preterm birth between pregnant women with and without disabilities. Methods A total of 2999 pregnant women aged ≥20 years with birth records in 2011-2014 in Taiwan were enrolled. Data were obtained from the Registration File for Physical and Mental Disabilities and the National Health Insurance Research Database. A 1:4 matching between pregnant women with disabilities and those without disabilities was performed. The logistic regression analysis with generalized estimating equations was used to analyze. Results The median of prenatal care services used by pregnant women with disabilities was 9.00 (interquartile range, IQR: 2.00). Pregnant women with disabilities used fewer services than those without disabilities (median, 10.00; IQR: 1.00). The disabled group (8.44%) had a significantly higher proportion of preterm births than did the non-disabled group (5.40%). The disabled group was at a 1.30 times higher risk of preterm births than was the non-disabled group. Conclusions Pregnant women with disabilities used significantly fewer prenatal care services and had a significantly higher risk of preterm birth than pregnant women without disabilities.
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Affiliation(s)
- Meng-Bin Tang
- Department of Public Health, Graduate Institute of Public Health, China Medical University, Taichung, Taiwan,Department of Health Services Administration, China Medical University, Taichung, Taiwan,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan,*Correspondence: Wen-Chen Tsai ✉
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McKee KS, Akobirshoev I, McKee M, Li FS, Mitra M. Postpartum Hospital Readmissions Among Massachusetts Women Who are Deaf or Hard of Hearing. J Womens Health (Larchmt) 2023; 32:109-117. [PMID: 36040351 PMCID: PMC10024058 DOI: 10.1089/jwh.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Deaf or hard of hearing (DHH) women are at a higher risk of adverse pregnancy and birth outcomes compared with other women. However, little is known about postpartum outcomes among DHH women. The objective was to compare the risk of postpartum hospitalizations for DHH compared with non-DHH women and the leading indications for postpartum admissions. Materials and Methods: We analyzed data from the 1998-2017 Massachusetts Pregnancy to Early Life Longitudinal Data System and identified 3,546 singleton deliveries to DHH women and 1,381,439 singleton deliveries to non-DHH women. We used Cox proportional hazard models to compare the first hospital admission and ≥2 hospital admissions between DHH and non-DHH women within 1-42, 43-90, and 91-365 days after delivery. Results: DHH women had a higher risk for any hospital admissions across all periods (hazard ratios [HR] = 1.84; 95% confidence intervals [CI] 1.46-2.34 within 1-42 days; HR = 2.76; 95%CI 1.99-3.83 within 43-90 days; and HR = 3.10; 95%CI 2.66-3.60 91-365 days) after childbirth compared with non-DHH women. They had an almost seven times higher risk for repeated hospital admissions within 43-90 days (HR = 6.84; 95%CI 1.66-28.21) and nearly four times higher the risk within 91-365 days (HR = 3.63; 95%CI 2.00-6.59) after delivery compared with non-DHH women. The leading indications for readmission among DHH women included: conditions complicating the puerperium/hemorrhage and soft tissues disorders. Conclusion: Compared with other women, DHH women had significantly higher readmissions across all postpartum periods and for repeated admissions >42 days. Leading postpartum indications were distinct from those of non-DHH women.
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Affiliation(s)
- Kimberly S. McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - Michael McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank S. Li
- Lurie Institute for Disability Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School, Brandeis University, Waltham, Massachusetts, USA
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McKee M, James TG, Helm KVT, Marzolf B, Chung DH, Williams J, Zazove P. Reframing Our Health Care System for Patients With Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3633-3645. [PMID: 35969852 PMCID: PMC9802570 DOI: 10.1044/2022_jslhr-22-00052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 06/04/2023]
Abstract
PURPOSE Nearly 20% of U.S. Americans report a hearing loss, yet our current health care system is poorly designed and equipped to effectively care for these individuals. Individuals with hearing loss report communication breakdowns, inaccessible health information, reduced awareness and training by health care providers, and decreased satisfaction while struggling with inadequate health literacy. These all contribute to health inequities and increased health care expenditures and inefficiencies. It is time to reframe the health care system for these individuals using existing models of best practices and accessibility to mitigate inequities and improve quality of care. METHOD A review of system-, clinic-, provider-, and patient-level barriers, along with existing and suggested efforts to improve care for individuals with hearing loss, are presented. RESULTS These strategies include improving screening and identification of hearing loss, adopting universal design and inclusion principles, implementing effective communication approaches, leveraging assistive technologies and training, and diversifying a team to better care for patients with hearing loss. Patients should also be encouraged to seek social support and resources from hearing loss organizations while leveraging technologies to help facilitate communication. CONCLUSIONS The strategies described introduce actionable steps that can be made at the system, clinic, provider, and patient levels. With implementation of these steps, significant progress can be made to more proactively meet the needs of patients with hearing loss. Presentation Video: https://doi.org/10.23641/asha.21215843.
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Affiliation(s)
- Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Tyler G. James
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Kaila V. T. Helm
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Brianna Marzolf
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - Dana H. Chung
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
| | - John Williams
- Department of Population Health Science, University of Mississippi Medical Center, Jackson
| | - Philip Zazove
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor
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Reproductive Justice for the Deaf Community. Obstet Gynecol 2022; 140:560-564. [PMID: 36075071 PMCID: PMC9484760 DOI: 10.1097/aog.0000000000004944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/14/2022] [Indexed: 01/05/2023]
Abstract
Almost half of all pregnancies each year in the United States are mistimed or unwanted and associated with adverse health outcomes. Deaf women are as likely to be pregnant as their hearing counterparts but are 67% more likely to experience unintended pregnancy. Although there are limited data on the sexual health behaviors of deaf individuals, research has shown that deaf people are more likely than the general population to rely on withdrawal and condoms to prevent pregnancy. Further, health resources and communication with physicians are often not fully accessible, with the former often in spoken or written English and the latter when sign language interpreters are not present. The combination of use of less--effective methods of contraception and inaccessible health resources puts deaf women at heightened risk for unintended pregnancy. Deaf women are denied reproductive justice when they are inadequately equipped to practice bodily autonomy and prevent unintended pregnancies. In this commentary, I present literature to illustrate the disparity deaf women face compared with hearing women and to make the case for the association among unintended pregnancy, its adverse effects, and reproductive injustice for deaf women. As a medically trained deaf woman conducting reproductive health research, I leverage my lived experience and accrued knowledge to elucidate the shortcomings and strategies to use. As public health researchers and health care professionals, we can alleviate this injustice with inclusive research methodology, representation on research and health care teams, and ensuring access to health information with time given and accommodations provided.
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García MH, Parker SE, Petersen JM, Rubenstein E, Werler MM. Birth outcomes among women with congenital neuromuscular disabilities. Disabil Health J 2021; 15:101259. [PMID: 34980574 DOI: 10.1016/j.dhjo.2021.101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Women with disabilities are at an increased risk for adverse birth outcomes; however, research among women with congenital neuromuscular disabilities (CNMD) is limited. OBJECTIVE To describe characteristics and compare birth outcomes among mothers with and without cNMD. METHODS Data were from the Slone Birth Defects Study (case-control, conducted from 1976 to 2015), which collected information on demographic, reproductive, and lifestyle characteristics. cNMD included spina bifida, cerebral palsy, muscular dystrophy, contractures, or arthrogryposis and were identified by participant report. Those with cNMD were matched to participants without cNMD by interview year and study site. We use modified Poisson regression to estimate relative risks (RR) for low birthweight, macrosomia, preterm birth, and small/large-for-gestational age (SGA/LGA). Given the case-control design and overrepresentation of infants with congenital anomalies, data were weighted to reflect a 3% national prevalence of infants with congenital anomalies. RESULTS Mothers with cNMD (n = 125) were more likely to be white, nulliparous, have a cesarean section, have an unplanned pregnancy, report a pre-pregnancy BMI ≥25 kg/m2, smoke during pregnancy, and report genitourinary infections. Mothers with cNMD had infants with shorter gestational length (mean difference: -7.44 days, 95% CI: -13.94, -0.95) compared to mothers without cNMD. cNMD was associated with higher risk of preterm birth (RR = 3.98, 95% CI: 1.33, 11.95) and SGA (RR = 2.14, 95% CI: 0.74, 6.15). CONCLUSION Mothers with cNMD were more likely to deliver preterm and have an SGA infant. These findings highlight disparities faced by mothers with cNMD and stress the need to provide optimal perinatal and reproductive care.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA.
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
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Luton M, Allan HT, Kaur H. Deaf women's experiences of maternity and primary care: An integrative review. Midwifery 2021; 104:103190. [PMID: 34763178 DOI: 10.1016/j.midw.2021.103190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An estimated 24,000 people in the UK report using British Sign Language (BSL) as their first language. Misconceptions about deaf culture and language mean that deaf people have less access to health information and their health literacy is lower. Deaf people's health needs go under the radar in primary care with ensuing poorer health outcomes. Deaf women's experiences of maternity care are poorly understood. METHODS Using Whittemore and Knafl's method for an integrative review, the following databases were searched: EMBASE, MedLine, CINAHL and Maternity and Infant Care. After reviewing 430 journal article titles and abstracts against the inclusion/exclusion criteria, 11 articles were included for final review. Selected studies were conducted internationally and were available in English. 10 were qualitative studies, 1 used survey design. They were reviewed using the Caldwell Framework. FINDINGS These show that deaf women avoid seeking care, have a lack of access to health information and healthcare providers, including midwives, have a lack of deaf awareness. For deaf women, during pregnancy, birth and postnatal periods, this can mean having longer hospital stays and more complex postnatal care needs in both the hospital and community setting. CONCLUSIONS Current care provisions do not always meet the needs of the deaf BSL using women who use maternity services. Midwives should be aware of deafness as a culture and how to best meet the needs of the community to improve health outcomes for women and their babies.
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Affiliation(s)
- Meghan Luton
- Child Health & Midwifery, Middlesex University, The Burroughs Hendon, London NW4 4BT, UK.
| | - Helen T Allan
- Centre for Critical Research in Nursing & Midwifery, Adult Nursing, Child Health & Midwifery, Middlesex University, UK
| | - Herminder Kaur
- Department of Criminology & Sociology, Middlesex University, UK
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Contraceptive Provision and Quality Care Measures for Insured Individuals in Massachusetts Who Are Deaf or Hard of Hearing. Obstet Gynecol 2021; 138:398-408. [PMID: 34352855 DOI: 10.1097/aog.0000000000004505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate contraceptive provision and contraceptive care quality measures for individuals who are deaf or hard of hearing and compare these outcomes to those individuals who are not. METHODS We conducted a claims analysis with data from the 2014 Massachusetts All-Payer Claims Database. Among premenopausal enrollees aged 15-44, we determined provision of any contraception (yes or no) and provision by contraception type: prescription contraception (pills, patch, ring, injectables, or diaphragm), long-acting reversible contraceptive (LARC) devices, and permanent contraception (tubal sterilization). We compared these outcomes by deaf or hard-of-hearing status (yes or no). The odds of contraceptive provision were calculated with regression models adjusted for age, Medicaid insurance, a preventive health visit, and deaf or hard-of-hearing status. We calculated contraceptive care quality measures, per the U.S. Office of Population Health, as the percentage of enrollees who used: 1) LARC methods or 2) most effective or moderately effective methods (tubal sterilization, pills, patch, ring, injectables, or diaphragm). RESULTS We identified 1,171,838 enrollees at risk for pregnancy; 13,400 (1.1%) were deaf or hard of hearing. Among individuals who were deaf or hard of hearing, 31.4% were provided contraception (23.5% prescription contraception, 5.4% LARC, 0.7% tubal sterilization). Individuals who were deaf or hard of hearing were less likely to receive prescription contraception (adjusted odds ratio 0.92, 95% CI 0.88-0.96) than individuals who were not deaf or hard of hearing. The percentage of individuals who were deaf or hard of hearing who received most effective or moderately effective methods was less than that for individuals who were not (24.2% vs 26.3%, P<.001). There were no differences in provision of LARC or permanent contraception by deaf and hard-of-hearing status. CONCLUSION Individuals who were deaf or hard of hearing were less likely to receive prescription contraception than individuals who were not; factors underlying this pattern need to be examined. Provision of LARC or permanent contraception did not differ by deaf or hard-of-hearing status. These findings should be monitored and compared with data from states with different requirements for contraceptive coverage.
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Adigun OT, Akinrinoye O, Obilor HN. Including the Excluded in Antenatal Care: A Systematic Review of Concerns for D/deaf Pregnant Women. Behav Sci (Basel) 2021; 11:67. [PMID: 34062909 PMCID: PMC8147384 DOI: 10.3390/bs11050067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
This paper presents global evidence derived from a systematic review of the literature on the issues of D/deaf pregnant women and antenatal care. A comprehensive search through four bibliographic databases identified a dataset of 10,375 academic papers, from which six papers met the inclusion criteria for in-depth analysis related to D/deaf pregnant women's use of antenatal care/clinics. Findings from the analysis revealed four major concerns for D/deaf pregnant women who attended antenatal clinics for care. These concerns were communication difficulties, satisfaction with antenatal care services, attendance at antenatal clinics, and associated health outcomes. Based on the identified issues and concerns, it is recommended that pre- and in-service healthcare workers should be trained on how to communicate through sign language with their D/deaf patients. In addition, there is a need to rapidly expand the body of knowledge on the issues concerning antenatal care for D/deaf pregnant women vis-à-vis their relationship with healthcare workers in antenatal facilities.
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Affiliation(s)
- Olufemi Timothy Adigun
- Department of Educational Psychology and Special Education, Faculty of Education, University of Zululand, KwaDlangezwa, Durban 3886, South Africa
| | - Olugbenga Akinrinoye
- Department of Paediatrics, College of Medicine, University College Hospital, Ibadan 200221, Nigeria;
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Mitra M, McKee MM, Akobirshoev I, Ritter GA, Valentine AM. Pregnancy and Neonatal Outcomes Among Deaf or Hard of Hearing Women: Results From Nationally Representative Data. Womens Health Issues 2021; 31:470-477. [PMID: 33888398 DOI: 10.1016/j.whi.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/05/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of the pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States. OBJECTIVE To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data. STUDY DESIGN We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics. RESULTS DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p < .001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p < .001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p < .001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p < .01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p < .01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p < .01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p < .01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p < .001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p < .001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p < .001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p < .001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p < .001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained. CONCLUSIONS DHH women are at an increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453.
| | - Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
| | - Grant A Ritter
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Anne M Valentine
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, 02453
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Smithson CA, McLachlan HL, Newton MS, Smith C, Forster DA. Perinatal outcomes of women with a disability who received pregnancy care through a specialised disability clinic in Melbourne, Australia. Aust N Z J Obstet Gynaecol 2021; 61:548-553. [PMID: 33772765 DOI: 10.1111/ajo.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Australia, it is estimated that 9.5% of women of childbearing age have a disability; however, little is known about their perinatal outcomes. Disability status is not routinely recorded in perinatal datasets. AIMS To compare the outcomes of women with a disability who received pregnancy care through a specialised disability clinic at the Royal Women's Hospital (the Women's) in Melbourne, Australia with hospital-wide perinatal outcome data. MATERIALS AND METHODS Routinely collected perinatal data for women who received pregnancy care from the 'Women with Individual Needs' (WIN) clinic from 2014-2018 (N = 111) were analysed and then compared with routinely collected electronic hospital data obtained from all women who had given birth at the Women's in 2017 and 2018 (N = 15 024). RESULTS Women who attended the WIN clinic were more likely to have a caesarean section birth (52% vs 32%; P < 0.001) and give birth preterm (17% vs 4%; P < 0.001) than those in the hospital-wide cohort. Their infants were more likely to be low birthweight (20% vs 9%; P < 0.001), require resuscitation (35% vs 11%; P < 0.001), be admitted to the Neonatal Intensive Special Care Unit (29% vs 13%; P < 0.001) and receive formula in hospital (54% vs 28%; P < 0.001) compared to infants in the other group. CONCLUSIONS Routine maternity data collection should include identification of women with a disability to enable appropriate support and to allow further exploration of potential poorer outcomes on a larger sample, to help identify factors amenable to interventions that may improve outcomes.
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Affiliation(s)
- Charlie A Smithson
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Cherise Smith
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Della A Forster
- The Royal Women's Hospital, Melbourne, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
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Tarasoff LA, Murtaza F, Carty A, Salaeva D, Hamilton AD, Brown HK. Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis. Pediatrics 2020; 146:peds.2020-1635. [PMID: 33203648 PMCID: PMC7786829 DOI: 10.1542/peds.2020-1635] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring. OBJECTIVE We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes. DATA SOURCES Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020. STUDY SELECTION Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English. DATA EXTRACTION We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses. RESULTS Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes. LIMITATIONS Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation. CONCLUSIONS In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.
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Affiliation(s)
- Lesley A. Tarasoff
- Department of Health and Society and,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | | | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Dinara Salaeva
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Hilary K. Brown
- Department of Health and Society and,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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