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Homelessness During Pregnancy: A Unique, Time-Dependent Risk Factor of Birth Outcomes

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Abstract

Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth outcomes. 9,995 mothers of children <48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child’s birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW; <2,500 g) and preterm delivery (<37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, comparing prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p < 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight (p = 0.08). Postnatal homelessness was not associated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a marker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide housing and health care to homeless women during pregnancy may result in improved birth outcomes.

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Abbreviations

LBW:

Low birth weight

PRAMS:

Pregnancy Risk Assessment Monitoring System (PRAMS)

AOR:

Adjusted odds ratio

CI:

Confidence interval

WIC:

Special Supplemental Nutrition Program for Women, Infants and Children

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Acknowledgments

The authors acknowledge Ingrid Weiss, Justin Pasquariello, and Allison Bovell for their invaluable assistance in preparation of this manuscript, as well as the Children’s HealthWatch interviewers, administrative staff, and participants. This work was supported by a grant from the Gerald D. and Katherine T. MacArthur Foundation.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA

    Diana B. Cutts

  2. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA

    Sharon Coleman, Stephanie Ettinger de Cuba & Timothy C. Heeren

  3. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA

    Maureen M. Black

  4. Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, PA, USA

    Mariana M. Chilton

  5. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA

    John T. Cook, Alan Meyers, Megan Sandel & Deborah A. Frank

  6. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Patrick H. Casey

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  1. Diana B. Cutts
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Correspondence to Diana B. Cutts.

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Cutts, D.B., Coleman, S., Black, M.M. et al. Homelessness During Pregnancy: A Unique, Time-Dependent Risk Factor of Birth Outcomes. Matern Child Health J 19, 1276–1283 (2015). https://doi.org/10.1007/s10995-014-1633-6

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  • DOI: https://doi.org/10.1007/s10995-014-1633-6

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