200 Homelessness in pregnancy is associated with adverse maternal and neonatal outcomes

Abstract

The objective of this study was to evaluate the effects of homelessness in pregnancy on obstetrical, neonatal and postpartum outcomes. We conducted a retrospective cohort analysis of all deliveries at a large urban public teaching hospital between January 1st, 2017 and December 31st, 2017. Homeless women who delivered during this period were compared to age-matched controls. Data was collected on demographics, prenatal care, and obstetrical, neonatal and postpartum outcomes. There were 1425 total deliveries at our institution between January 1st, 2017 and December 31st, 2017. Ultimately 67 patients (4.7%) were identified as homeless; the majority, 39 (58.2%) were shelter-housed. Our final cohort included 67 homeless patients and 67 domiciled controls (4.9% of total domiciled patients). Homeless patients were less likely to have a vaginal delivery (61.2% vs 77.6%, p=0.017). Their neonates had longer NICU stays (27.3 days vs 7.5 days, p=0.008). The mean birthweight for neonates born to homeless patients was 2864g as compared to 3174g for controls (p= 0.006). Homeless patients were more likely to be evaluated by the Administration for Children’s Services (ACS) (15% vs 2%, p = 0.016). Homeless women were also less likely to exclusively breastfeed in the 6 weeks following delivery (28.3% vs 53.7%, p=0.005). Homeless women are less likely to have a vaginal delivery and to exclusively breastfeed during the immediate postpartum period, and more likely to be referred for evaluation by the Administration for Children’s Services. Their neonates have longer NICU stays and a lower average birthweight than that of their non-homeless counterparts. Homelessness should be considered as a social determinant of health that may have an unrecognized and severe impact on maternal and neonatal health, and warrants further exploration. We plan to evaluate our findings more in-depth to explore these associations.