Addressing Severe Maternal Morbidity of Deaf and Hard of Hearing Individuals by Targeting Clinical and Health System Factors

Deaf and hard of hearing (DHH) women are at substantially higher risk of adverse birth outcomes and severe maternal morbidity and mortality (SMMM), a composite measure of 21 indicators of life-threatening pregnancy-related health problems, compared to non-DHH populations. Preliminary data indicate DHH-Black pregnant women may be at even further elevated risk of SMMM compared to white non-disabled pregnant women, which suggests intersectional axes, the overlapping of social identities that interact and may compound SMMM risk. Obstetrical toolkits that bundle evidenced based practices are one approach to address disparities, but none are tailored to specific patient populations, suggesting an urgent gap in care. The study objectives are to identify the leading SMMM indicators of DHH and DHH-Black intersectional disparities and develop a patient-informed obstetrical toolkit with the long-term goal of improving SMMM. We hypothesize that the leading clinical indicators for SMMM will be distinct in DHH and DHH-Black women compared to non-DHH/non-Black women, and DHH-Black women will have compounded risk and higher burdens of comorbidities, social determinants of health and inadequate prenatal care. The specific aims are to: 1a) Compare the clinical indicators for SMMM, and test how health system factors such as obstetric comorbidity scores, social determinants of health, and the prenatal care adequacy contribute to SMMM in DHH and DHH-Black compared to non-DHH/non-Black cohorts nationally; 1b) Use linked longitudinal claims data from Massachusetts and South Carolina to compare DHH and DHH-Black compared to non-DHH/non-Black women’s risk of SMMM, the timing of greatest vulnerability in the perinatal period, hospital facility factors, and healthcare utilization (readmissions and visits) from pregnancy to one year postpartum; 2) Gain patient perspectives of Aim 1 health system and clinician factors that contribute to SMMM; and 3) Develop a toolkit informed by Aims 1 and 2 results. The expected outcomes are much needed epidemiologic evidence on the leading indicators and contributors of SMMM in DHH women and a patient-informed obstetrical toolkit to reduce SMMM with future potential for adaptation to other populations. Project Number: 1R01HD119006-01 | Fiscal Year: 2025 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Kimberly McKee (+1 co-PI) | Institution: UNIVERSITY OF MICHIGAN AT ANN ARBOR, ANN ARBOR, MI | Award Amount: $1,573,144 | Activity Code: R01 | Study Section: Healthcare and Health Disparities Study Section[HHD] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11900601