Housing instability and adverse perinatal outcomes: a systematic review

Area of Science:

• Reproductive Health
• Public Health
• Social Determinants of Health

Background:

• Housing instability, including homelessness, is a critical social determinant affecting maternal and infant health.
• Limited research exists on the specific impacts of housing instability during pregnancy on adverse pregnancy outcomes and healthcare utilization.
• Understanding these associations is vital for developing targeted interventions and improving perinatal care.

Purpose of the Study:

• To systematically review published literature on the association between housing instability during pregnancy and adverse pregnancy outcomes.
• To examine the relationship between housing instability during pregnancy and perinatal healthcare utilization.
• To identify gaps in the literature and suggest future research directions.

Main Methods:

• Systematic search of Embase, MEDLINE, Cochrane Library, and Scopus databases (November 2020).
• Inclusion of observational studies (cohort, cross-sectional) examining housing instability, adverse pregnancy outcomes, and perinatal healthcare utilization in the United States.
• Data extraction and quality assessment using GRADE and NIH Study Quality Assessment Tools by two independent reviewers.

Main Results:

• Fourteen observational studies were included, with significant heterogeneity in defining housing instability.
• Housing instability and homelessness during pregnancy were associated with increased risks of preterm birth, low birthweight, NICU admission, and delivery complications.
• Associations were also found with inadequate prenatal care and increased hospital utilization, though study quality was generally low to very low.

Conclusions:

• A consistent relationship between housing instability during pregnancy and adverse outcomes is suggested, despite data limitations.
• The lack of a standardized definition for housing instability hinders comprehensive analysis and intervention development.
• Developing standardized definitions and measurements is crucial for future interventions targeting housing instability in pregnant individuals.