Homelessness during pregnancy tied to poor maternal, infant health outcomes

Key takeaways:

• Women who reported homelessness during pregnancy had worse outcomes, including hypertension and diabetes.
• Infants born to mothers experiencing homelessness were more likely to be born small for gestational age.

Women who reported experiencing homelessness during the year before giving birth were more likely to have delayed prenatal care and develop hypertension, diabetes and postpartum depression vs. women who reported adequate housing, data show.

In an analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) survey data, researchers also found that homeless mothers were also more likely to deliver an infant born small for gestational age, highlighting the impact of adequate housing on public health.

“A multistate study using self-reported housing status demonstrated that experiencing homelessness is associated with behaviors known to affect pregnancy health (eg, smoking), but used data from 2000 to 2007,” Mark E. McGovern, PhD, a health economist and associate professor in the department of health behavior, society and policy at the Rutgers School of Public Health, and colleagues wrote in JAMA Network Open. “We hypothesized homelessness affects maternal, infant and child health through three main mechanisms: reduced use of primary care due to residential instability and elevated barriers to routine medical services; higher rates of stress-induced health behaviors such as smoking; and elevated allostatic load and anxiety.”

For the cross-sectional study, researchers analyzed data from 146,943 postpartum people who participated in PRAMS, a cross-sectional survey of people with live births across 25 states and New York City. Researchers pooled PRAMS phase 8 datasets (2016-2021) from all states asking whether postpartum people were “homeless or had to sleep outside, in a car or in a shelter” in the year before delivery.

Within the cohort, 2.4% reported homelessness during the year before giving birth.

Compared with those without homelessness experiences, postpartum people who experienced homelessness were more likely to report their race as Black (34% vs. 14.9%), be unmarried and have high school education or less.

Researchers found that homelessness was negatively associated with maternal, infant and child health outcomes after adjusting for potential confounders. Adjusted RRs were:

• 1.16 for the pregnancy month of the first prenatal checkup (95% CI, 1.12-1.2);
• 1.21 for hypertension during pregnancy (95% CI, 1.09-1.35);
• 1.36 for diabetes during pregnancy (95% CI, 1.18-1.56);
• 1.83 for postpartum depression (95%CI, 1.68-1.99); and
• 1.17 (95% CI, 1.03-1.34) for delivering an infant small for gestational age.

“While PRAMS data are only representative of included states, applying the 2.4% homelessness rate to all U.S. births in 2023 implies 70,000 babies would be born within 12 months of maternal homelessness,” the researchers wrote. “We expect increasing numbers of postpartum people to be affected and concomitant inequities to widen with expiration of pandemic-era renter protections.”

The researchers noted that self-reports of homelessness may understate population prevalence and more longitudinal analyses are needed to identify whether supportive interventions can improve maternal, infant and child health among postpartum people who have experienced homelessness.