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New study shows homeless women more likely to face pregnancy complications

By Lisa M. Larson

UMass Medical School Communications

January 08, 2019
  Robin Clark, PhD
 

Robin Clark, PhD

A new study in the January issue of Health Affairs shows that women who were homeless during their pregnancies had significantly higher rates of health complications, such as hypertension, anemia, hemorrhage and early labor, compared with those who were not homeless.

The study, by Robin Clark, PhD, professor of family medicine & community health, and co-authored by Linda Weinreb, MD, professor of family medicine & community health; Robert Seifert, MPA, executive director of health law & policy at UMass Medical School; and Julie Flahive, MS, linked data from emergency shelter enrollees with Massachusetts Medicaid claims to compare health care use and pregnancy complications for approximately 9,100 women who used emergency shelter and 8,800 who did not.

“Homelessness during pregnancy poses significant health risks for mothers and infants,” Dr. Clark said. “As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy.”

Rates of mental illness and substance use disorders were significantly higher among homeless women, the study reports. After adjusting for behavioral health disorders, the rates of homeless women having nine pregnancy complications were still significantly higher than women who were not homeless. The authors also found that the homeless women had fewer ambulatory care visits, more months without billable care and were more likely to visit an emergency department.

Homelessness and behavioral health disorders appear to be independent factors contributing to pregnancy complications and should be addressed simultaneously, the authors concluded.