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Maternal and Child Health Journal

, Volume 19, Issue 6, pp 1276–1283 | Cite as

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

  • Diana B. CuttsEmail author
  • Sharon Coleman
  • Maureen M. Black
  • Mariana M. Chilton
  • John T. Cook
  • Stephanie Ettinger de Cuba
  • Timothy C. Heeren
  • Alan Meyers
  • Megan Sandel
  • Patrick H. Casey
  • Deborah A. Frank
Article

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.

Keywords

Pregnancy Homeless Low birth weight (LBW) Preterm delivery Housing Maternal 

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

Notes

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.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Diana B. Cutts
    • 1
    Email author
  • Sharon Coleman
    • 2
  • Maureen M. Black
    • 3
  • Mariana M. Chilton
    • 4
  • John T. Cook
    • 5
  • Stephanie Ettinger de Cuba
    • 2
  • Timothy C. Heeren
    • 2
  • Alan Meyers
    • 5
  • Megan Sandel
    • 5
  • Patrick H. Casey
    • 6
  • Deborah A. Frank
    • 5
  1. 1.Department of PediatricsHennepin County Medical CenterMinneapolisUSA
  2. 2.Data Coordinating CenterBoston University School of Public HealthBostonUSA
  3. 3.Department of PediatricsUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Department of Health Management and PolicyDrexel University School of Public HealthPhiladelphiaUSA
  5. 5.Department of PediatricsBoston University School of MedicineBostonUSA
  6. 6.Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockUSA

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