Homelessness Contributes To Pregnancy Complications

Clark, Robin E.; Flahive, Julie; Seifert, Robert W.

doi:10.1377/hlthaff.2018.05156

Cited by 51 publications

(73 citation statements)

References 24 publications

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“…The screening process yielded 14 studies meeting inclusion criteria (Figure 1). 1,2,[21][22][23][24][25][26][27][28][29][30][31][32] All studies were observational; studies were either retrospective cohort studies (n=10, 71.4%), cross-sectional observational studies (n=3, 21.4%), or prospective cohort studies (n=1, 7.1%). (Table 1)…”

Section: A Study Selectionmentioning

confidence: 99%

“…The majority of studies included individual race, age, mental health history, or substance use as covariates in adjusted logistic regression models. 1,2,18,21,23,25,26,29,30,32…”

Section: Study Quality and Risk Of Biasmentioning

confidence: 99%

“…12,13 Social determinants of health are known to influence perinatal morbidity. 14,15 With regard to housing, pregnant individuals who report housing instability are more likely to self-identify as non-Hispanic Black, be younger, less educated, and low income compared to those with stable housing; [16][17][18] all of these sociodemographic factors have been associated with adverse pregnancy outcomes. 14…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Housing instability and adverse perinatal outcomes: a systematic review

DiTosto¹,

Holder²,

Beestrum³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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Section: A Study Selectionmentioning

confidence: 99%

“…The majority of studies included individual race, age, mental health history, or substance use as covariates in adjusted logistic regression models. 1,2,18,21,23,25,26,29,30,32…”

Section: Study Quality and Risk Of Biasmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Housing instability and adverse perinatal outcomes: a systematic review

DiTosto¹,

Holder²,

Beestrum³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

View full text Add to dashboard Cite

“…[16][17][18] However, existing research is limited to small studies conducted at a single hospital, 17,19 city (ie, Los Angeles), 18 or state (ie, Massachusetts). 20 Therefore, whether their findings are generalizable to other regions of the US remains unclear. Moreover, prior studies compared women experiencing homelessness vs those not experiencing homelessness across hospitals; therefore, observed disparities in health outcomes may be associated with differences in the quality of hospitals from which women sought care.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness

et al. 2021

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IMPORTANCE Women and families constitute the fastest-growing segments of the homeless population. However, there is limited evidence on whether women experiencing homelessness have poorer childbirth delivery outcomes and higher costs of care compared with women not experiencing homelessness. OBJECTIVETo compare childbirth delivery outcomes and costs of care between pregnant women experiencing homelessness vs those not experiencing homelessness. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included 15 029 pregnant women experiencing homelessness and 308 242 pregnant women not experiencing homelessness who had a delivery hospitalization in 2014. The study used statewide databases that included all hospital admissions in 3 states (ie, Florida, Massachusetts, and New York). Delivery outcomes and delivery-associated costs were compared between pregnant women experiencing homelessness and those not experiencing homelessness cared for at the same hospital (analyzed using the overlap propensity-score weighting method and multivariable regression models with hospital fixed effects).The Benjamini-Hochberg false discovery rate procedure was used to account for multiple comparisons. Data were analyzed from January 2020 through May 2020.EXPOSURE Housing status at delivery hospitalization. MAIN OUTCOMES AND MEASURES Outcome variables included obstetric complications (ie,antepartum hemorrhage, placental abnormalities, premature rupture of the membranes, preterm labor, and postpartum hemorrhage), neonatal complications (ie, fetal distress, fetal growth restriction, and stillbirth), delivery method (ie, cesarean delivery), and delivery-associated costs. RESULTS Among 15 029 pregnant women experiencing homelessness (mean [SD] age, 28.5 [5.9] years) compared with 308 242 pregnant women not experiencing homelessness (mean [SD] age, 29.4 [5.8] years) within the same hospital, those experiencing homelessness were more likely to experience preterm labor (adjusted probability, 10.

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“…In the same population of mothers, eviction was associated with a 21% increase in the probability of depression and a 19% increase in self-reported parenting stress [14]. Subsequently, a number of studies have found housing insecurity and homelessness during pregnancy to be associated with pregnancy complications [15,16], preterm birth, and low birth weight [17][18][19]. Recent studies show that pregnant women living in neighborhoods rendered unstable by evictions and tax foreclosures may be more likely to deliver very low birth weight or preterm infants, particularly if the women have low educational attainment [20,21].…”

Section: Introductionmentioning

confidence: 99%

Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes

Leifheit

Schwartz

Pollack

et al. 2020

IJERPH

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Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure–outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth (risk ratio (RR] 1.73, 95% confidence interval (CI) 1.28, 2.32), NICU or stepdown stay (RR 1.64, CI 1.17, 2.31), and extended hospitalization (RR 1.66, CI 1.28, 2.16). Associations between housing insecurity and infant fair or poor health (RR 2.62, CI 0.91, 7.48) and poor temperament (RR 1.52, CI 0.98, 2.34) were not statistically significant. PAF estimates ranged from 0.9–2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families.

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Homelessness Contributes To Pregnancy Complications

Cited by 51 publications

References 24 publications

Housing instability and adverse perinatal outcomes: a systematic review

Housing instability and adverse perinatal outcomes: a systematic review

Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness

Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes

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