123 Is housing instability a social determinant of prenatal care utilization and perinatal outcomes?

Abstract

To evaluate whether housing instability is associated with differences in prenatal care utilization and perinatal outcomes. In this observational cohort study, women were surveyed during their postpartum hospitalization regarding housing instability during pregnancy and their medical records were reviewed. Women were considered housing unstable if they answered affirmatively to at least one of six screening items (Figure). The primary outcome was adequacy of prenatal care measured by the Adequacy of Prenatal Care Utilization index, comparing adequate or intermediate care versus inadequate care. Secondary maternal outcomes were gestational weight gain, cesarean delivery, and hypertensive disorders of pregnancy; neonatal outcomes were preterm birth, large for gestational age status, and NICU transfer. Propensity scoring was performed using sociodemographic and clinical covariates. Multivariable logistic regression models were adjusted for propensity score weighting. In this cohort (N=489), 11.0% (N=54) experienced housing instability during pregnancy. Unstably housed women were more likely to be minority race, have less than a college education, be single, be unemployed and have had a prior preterm birth. Unstably housed women were more likely to have had inadequate prenatal care (16.7% vs 3.9%, p<0.001), but findings were not significant after propensity score adjustment (Table). There was no statistically significant association with maternal or neonatal secondary outcomes. One in 10 women in this urban population experienced housing instability during pregnancy. Housing instability appears to be a risk marker that is related to other social determinants of health; however, in this population, it does not appear to be an independent risk factor for inadequate prenatal care or other perinatal outcomes. Given the range of housing instability experiences, future research must investigate specific types of housing instability and the potential perinatal consequences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)