Skip to main content

Advertisement

SpringerLink
Log in

Homelessness in Pregnancy and Increased Risk of Adverse Outcomes: A Retrospective Cohort Study

  • Original Article
  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Limited data indicates that homelessness during pregnancy is linked to adverse outcomes for both mothers and newborns, but there is an information gap surrounding pregnant individuals struggling with homelessness. In a landscape of increasing healthcare disparities, housing shortages and maternal mortality, information on this vulnerable population is fundamental to the creation of targeted interventions and outreach. The current study investigates homelessness as a risk factor for adverse obstetrical, neonatal, and postpartum outcomes. We reviewed more than 1000 deliveries over 1 year at a large public hospital in New York City, comparing homeless subjects to a group of age-matched, stably housed controls. Multiple outcomes were assessed regarding obstetrical, neonatal, and postpartum outcomes along with social stressors. Homeless pregnant individuals were more likely to experience numerous adverse outcomes, including cesarean delivery and preterm delivery. Their neonates were more likely to undergo an extended stay in the intensive care unit and evaluation by the Administration for Children’s Services, suggesting that they may be at an increased risk for family separation. After delivery, patients were less likely to exclusively breastfeed or return for their postpartum visit. Regarding personal history, they were more likely to endorse a history of violence or abuse, use illicit substances, and carry a psychiatric diagnosis. These findings indicate that homelessness is linked to numerous adverse obstetrical, neonatal, and postpartum outcomes that worsen health indices and exacerbate pre-existing disparities. Initiatives must focus on improved outreach and care delivery for homeless pregnant individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. De Sousa, T, Andrichik, A, Cuellar, M, Marson, J, Prestera, E et al. The 2022 Annual Homelessness Assessment Report (AHAR) to Congress. Published online December 2022. Accessed 20 Jul 2023. https://www.huduser.gov/portal/sites/default/files/pdf/2022-ahar-part-1.pdf.

  2. Mehdipanah R. Housing as a determinant of COVID-19 inequities. Am J Public Health. 2020;110(9):1369–70. https://doi.org/10.2105/AJPH.2020.305845.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Riley ED, Hickey MD, Imbert E, Clemenzi-Allen AA, Gandhi M. Coronavirus disease 2019 (COVID-19) and HIV spotlight the United States imperative for permanent affordable housing. Clin Infect Dis. 2021;72(11):2042–3. https://doi.org/10.1093/cid/ciaa1327.

    Article  CAS  PubMed  Google Scholar 

  4. Routhier, G. State of the Homeless 2020. Coalition for the homeless. Published online June 2020. Accessed 20 Jul 2023. https://www.coalitionforthehomeless.org/state-of-the-homeless/.

  5. Richards R, Merrill RM, Baksh L. Health behaviors and infant health outcomes in homeless pregnant women in the United States. Pediatrics. 2011;128(3):438–46. https://doi.org/10.1542/peds.2010-3491.

    Article  PubMed  Google Scholar 

  6. Cutts DB, Coleman S, Black MM, et al. Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes. Matern Child Health J. 2015;19(6):1276–83. https://doi.org/10.1007/s10995-014-1633-6.

    Article  PubMed  Google Scholar 

  7. Ake T, Diehr S, Ruffalo L, et al. Needs assessment for creating a patient-centered, community-engaged health program for homeless pregnant women. J Patient Cent Res Rev. 2018;5(1):36–44. https://doi.org/10.17294/2330-0698.1591. Published 2018 Jan 30.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness contributes to pregnancy complications. Health Aff (Millwood). 2019;38(1):139–46. https://doi.org/10.1377/hlthaff.2018.05156.

    Article  PubMed  Google Scholar 

  9. Bassuk EL, Weinreb L. Homeless pregnant women: two generations at risk. Am J Orthopsychiatry. 1993;63(3):348–57. https://doi.org/10.1037/h0085034.

    Article  CAS  PubMed  Google Scholar 

  10. Bassuk EL, Hart JA, Donovan E. Resetting policies to end family homelessness. Annu Rev Public Health. 2020;41:247–63. https://doi.org/10.1146/annurev-publhealth-040119-094256.

    Article  PubMed  Google Scholar 

  11. Reilly KH, Zimmerman R, Huynh M, Kennedy J, McVeigh KH. Characteristics of mothers and infants living in homeless shelters and public housing in New York City. Matern Child Health J. 2019;23(5):572–7. https://doi.org/10.1007/s10995-018-2672-1.

    Article  PubMed  Google Scholar 

  12. DiTosto JD, Holder K, Soyemi E, Beestrum M, Yee LM. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021;3(6):100477. https://doi.org/10.1016/j.ajogmf.2021.100477.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pantell MS, Baer RJ, Torres JM, et al. Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. Am J Obstet Gynecol MFM. 2019;1(4):100053. https://doi.org/10.1016/j.ajogmf.2019.100053.

    Article  PubMed  Google Scholar 

  14. United States Department of Housing and Urban Development. Criteria and recordkeeping requirements for definition of homelessness. Published January 2012. Accessed January 25, 2024. https://www.hudexchange.info/resource/1974/criteria-and-recordkeeping-requirements-for-definition-of-homeless/.

  15. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81. https://doi.org/10.1016/j.jbi.2008.08.010.

    Article  PubMed  Google Scholar 

  16. Kushel M. Homelessness: a potent risk factor for readmission. Med Care. 2018;56(6):457–9. https://doi.org/10.1097/MLR.0000000000000920.

    Article  PubMed  Google Scholar 

  17. Hack M, Schluchter M, Andreias L, et al. Change in prevalence of chronic conditions between childhood and adolescence among extremely low-birth-weight children [published correction appears in JAMA. 2011 Sep 7;306(9):933]. JAMA. 2011;306(4):394–401. https://doi.org/10.1001/jama.2011.1025.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Crump C, Sundquist J, Winkleby MA, Sundquist K. Gestational age at birth and mortality from infancy into mid-adulthood: a national cohort study. Lancet Child Adolesc Health. 2019;3(6):408–17. https://doi.org/10.1016/S2352-4642(19)30108-7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee JY, Kirsch J, Presley S, et al. Racial and ethnic disparities in the physical health outcomes of children in foster care: a systematic review [published online ahead of print, 2023 Jan 27]. Trauma Violence Abuse. 2023;15248380221145911. https://doi.org/10.1177/15248380221145911.

  20. McGeough C, Walsh A, Clyne B. Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: a qualitative evidence synthesis. Health Soc Care Community. 2020;28(5):1380–93. https://doi.org/10.1111/hsc.12972.

    Article  PubMed  Google Scholar 

  21. McKinney J, Keyser L, Clinton S, Pagliano C. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol. 2018;132(3):784–5. https://doi.org/10.1097/AOG.0000000000002849.

    Article  PubMed  Google Scholar 

  22. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496–506. https://doi.org/10.1542/peds.2004-2491.

    Article  PubMed  Google Scholar 

  23. Maniglio R. The impact of child sexual abuse on health: a systematic review of reviews. Clin Psychol Rev. 2009;29(7):647–57. https://doi.org/10.1016/j.cpr.2009.08.003.

    Article  PubMed  Google Scholar 

  24. Stewart DE. Clinical practice. Depression during pregnancy. N Engl J Med. 2011;365(17):1605–11. https://doi.org/10.1056/NEJMcp1102730.

    Article  CAS  PubMed  Google Scholar 

  25. Gouin K, Murphy K, Shah PS. Knowledge synthesis group on determinants of low birth weight and preterm births. Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and metaanalyses. Am J Obstet Gynecol. 2011;204(4):340.e1-340.e3412.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA

    Emma Gilmore, Karen Duncan & Veronica Ades

  2. Department of Obstetrics and Gynecology, University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA

    Emma Gilmore

  3. Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Building 1, BS27, Bronx, NY, 10461, USA

    Veronica Ades

Authors
  1. Emma Gilmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen Duncan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica Ades
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emma Gilmore.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gilmore, E., Duncan, K. & Ades, V. Homelessness in Pregnancy and Increased Risk of Adverse Outcomes: A Retrospective Cohort Study. J Urban Health 101, 383–391 (2024). https://doi.org/10.1007/s11524-024-00839-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-024-00839-x

Keywords

Search

Navigation