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Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes

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  • Kathryn M. Leifheit

    (Department of Health Policy and Management, Los Angeles Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA)

  • Gabriel L. Schwartz

    (Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, CA 94118, USA
    Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA)

  • Craig E. Pollack

    (Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
    School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA)

  • Kathryn J. Edin

    (Department of Sociology, Princeton University, Princeton, NJ 08544, USA
    School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA)

  • Maureen M. Black

    (Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
    RTI International, Research Triangle Park, NC 27709, USA)

  • Jacky M. Jennings

    (Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA)

  • Keri N. Althoff

    (Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

Abstract

Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure–outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth (risk ratio (RR] 1.73, 95% confidence interval (CI) 1.28, 2.32), NICU or stepdown stay (RR 1.64, CI 1.17, 2.31), and extended hospitalization (RR 1.66, CI 1.28, 2.16). Associations between housing insecurity and infant fair or poor health (RR 2.62, CI 0.91, 7.48) and poor temperament (RR 1.52, CI 0.98, 2.34) were not statistically significant. PAF estimates ranged from 0.9–2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families.

Suggested Citation

  • Kathryn M. Leifheit & Gabriel L. Schwartz & Craig E. Pollack & Kathryn J. Edin & Maureen M. Black & Jacky M. Jennings & Keri N. Althoff, 2020. "Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes," IJERPH, MDPI, vol. 17(22), pages 1-12, November.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:22:p:8659-:d:448928
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    References listed on IDEAS

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    1. Walters, Glenn D., 2014. "Pathways to early delinquency: Exploring the individual and collective contributions of difficult temperament, low maternal involvement, and externalizing behavior," Journal of Criminal Justice, Elsevier, vol. 42(4), pages 321-326.
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    Cited by:

    1. Schwartz, Gabriel L. & Leifheit, Kathryn M. & Arcaya, Mariana C. & Keene, Danya, 2024. "Eviction as a community health exposure," Social Science & Medicine, Elsevier, vol. 340(C).
    2. Feldman, Guy & Shwartz-Ziv, Tamar, 2024. "Negotiating housing insecurity: Parenting in poverty and the struggle for home," Children and Youth Services Review, Elsevier, vol. 163(C).
    3. Jason Reece, 2021. "More Than Shelter: Housing for Urban Maternal and Infant Health," IJERPH, MDPI, vol. 18(7), pages 1-17, March.

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