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Severity of homelessness predicts low birthweight and preterm births irrespective of risk factors and prenatal care

A study of severely impoverished homeless women in Los Angeles concludes that severity of homelessness leads to more low birthweight (LBW) and preterm babies, who are at increased risk of dying or having long-term neurodevelopmental and respiratory disorders. Severity of homelessness was based on the percentage of their lives during which the women were homeless, whether they were homeless while they were pregnant, and the number of times that they had been homeless. The study was supported in part by the Agency for Healthcare Research and Quality (HS08323) and led by Lillian Gelberg, M.D., M.S.P.H., of the University of California, Los Angeles.

The researchers interviewed 237 homeless women aged 15 through 44 years who had given birth within the last 3 years. Almost 17 percent of the women had low birthweight babies (less than 5.5 pounds), and 19 percent had preterm births (before 37 weeks' gestation) compared with the national average of 6 percent and 10 percent, respectively. Birth outcomes were worse for homeless women of color. For example, homeless black women were four times more likely to deliver an LBW baby and nearly three times more likely to deliver a premature baby then homeless white women. About 22 percent of black and 16 percent of Hispanic homeless women had LBW babies compared with 5.4 percent of homeless white women, and 21 percent of black and 14 percent of Hispanic homeless women had preterm births compared with 7.8 percent of homeless white women.

Greater severity of homelessness was a powerful predictor of poor birth outcomes for the entire group beyond risk factors that often accompany homelessness such as substance use and psychological distress. Long and frequent periods of chronic homelessness had an even stronger impact on adverse birth outcomes than homelessness during the first trimester of pregnancy. The resulting poor birth outcomes may have been due to inadequate nutrition and general neglect of health during homeless times, as well as chronically stressful and devastating life circumstances, explain the researchers. They conclude that prenatal care alone cannot be expected to reverse the cumulative and weathering effects of chronic homelessness on the reproductive health of homeless women.

More details are in "Severity of homelessness and adverse birth outcomes," by Judith A. Stein, Ph.D., Michael C. Lu, M.D., M.P.H., and Dr. Gelberg, in Health Psychology 19(6), pp. 524-534, 2000.

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