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Homelessness Contributes To Pregnancy Complications.
Robin E Clark1, Linda Weinreb2, Julie M Flahive3
1Robin E. Clark ( robin.clark@umassmed.edu ) is a professor of family medicine and community health, University of Massachusetts Medical School, in Worcester.
Health Affairs (Project Hope)
|January 8, 2019
Summary
Homelessness during pregnancy significantly increases health risks for mothers and infants. Addressing housing instability and behavioral health disorders simultaneously is crucial for improving pregnancy outcomes.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Services Research
Background:
- Homelessness during pregnancy presents considerable health risks to mothers and infants.
- Understanding the impact of unstable housing on pregnancy complications is vital as healthcare providers focus on social determinants of health.
Purpose of the Study:
- To compare healthcare utilization and pregnancy complications between women experiencing homelessness and housed women.
- To determine the independent contributions of homelessness and behavioral health disorders to adverse pregnancy outcomes.
Main Methods:
- Linked emergency shelter enrollment data with Massachusetts Medicaid claims (2008-2015).
- Compared healthcare use and pregnancy complications for 9,124 homeless women with 8,757 housed women.
- Utilized adjusted odds ratios to assess the impact of homelessness and behavioral health disorders.
Main Results:
- Homeless women had significantly higher rates of mental illness and substance use disorders.
- Homeless women faced significantly higher adjusted odds of nine pregnancy complications, independent of behavioral health disorders.
- Emergency shelter users exhibited reduced ambulatory care visits, increased periods without billable care, and higher emergency department utilization.
Conclusions:
- Homelessness and behavioral health disorders are independent risk factors for pregnancy complications.
- Simultaneous interventions addressing both housing instability and behavioral health are necessary for improving maternal and infant health outcomes.
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