Homelessness in Pregnancy and Increased Risk of Adverse Outcomes: A Retrospective Cohort Study
Emma Gilmore1,2, Karen Duncan3, Veronica Ades3,4
1Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA. emma.gilmore@gmail.com.
Summary
Homelessness during pregnancy significantly increases risks for adverse maternal and neonatal outcomes, including preterm birth and longer intensive care unit stays. Targeted interventions are crucial for this vulnerable population.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Neonatal Medicine
Background:
- Homelessness during pregnancy is understudied, despite links to adverse maternal and neonatal outcomes.
- Increasing healthcare disparities, housing shortages, and maternal mortality highlight the need for data on this population.
- Understanding the challenges faced by homeless pregnant individuals is vital for developing targeted interventions.
Purpose of the Study:
- To investigate homelessness as a risk factor for adverse obstetrical, neonatal, and postpartum outcomes.
- To compare outcomes of homeless pregnant individuals with those of age-matched, stably housed controls.
- To identify specific risks and challenges faced by pregnant individuals experiencing homelessness.
Main Methods:
- Retrospective review of over 1000 deliveries at a large public hospital in New York City.
- Comparison of outcomes between homeless pregnant individuals and a control group of stably housed individuals.
- Assessment of obstetrical, neonatal, and postpartum outcomes, including social stressors and personal history.
Main Results:
- Homeless pregnant individuals had higher rates of cesarean delivery and preterm delivery.
- Neonates born to homeless mothers were more likely to require intensive care unit (ICU) stays and undergo evaluation by the Administration for Children's Services (ACS).
- Postpartum, these patients were less likely to exclusively breastfeed or attend postpartum visits, and more likely to report a history of abuse, substance use, or psychiatric diagnoses.
Conclusions:
- Homelessness is significantly associated with numerous adverse obstetrical, neonatal, and postpartum outcomes.
- These adverse outcomes worsen health indices and exacerbate existing health disparities for pregnant individuals.
- Improved outreach and care delivery initiatives are essential for supporting homeless pregnant individuals and their newborns.
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