Prenatal Maternal Stress and Physical Abuse among Homeless Women and Infant Health Outcomes in the United States

Abstract

Background. This study examines whether the relationship between maternal stress or abuse situations and infant birth weight differs between homeless and non-homeless women. Methods. Analyses are based on data from the Pregnancy Risk Assessment Monitoring System (PRAMS), [2002][2003][2004][2005][2006][2007]. Results. Homeless women were significantly more likely to experience stressful life events, abusive situations, and poor maternal health than non-homeless women during pregnancy. Birth weight among infants of homeless women was, on average, 17.4 grams lighter than for infants of non-homeless women, after adjusting for maternal age, race, ethnicity, region, education, and marital status. The impact of maternal health, stress, and abuse variables on pregnancy and infant birth weight significantly interacted with homeless status. For example, vaginal bleeding, nausea, kidney/bladder infection, and failure to receive early prenatal care had significantly larger negative impacts on birth weight among homeless women than non-homeless women. Infant birth weight was consistently lower among homeless women, more so when maternal stress and abuse were involved, across all classifications of their prepregnancy weight. Conclusion. Stress and abusive situations among pregnant women have a negative influence on pregnancy-related conditions and infant birth weight. However, this negative influence is even more pronounced among homeless women.

Needs Assessment for Creating a Patient-Centered, Community-Engaged Health Program for Homeless Pregnant Women

“…Although the specific concerns expressed by the women during this needs assessment are common to many expectant and new mothers, the unique barriers, such as access to health care, transportation, or obtaining accurate information, are formidable for the homeless. 3,5,8,10,19 The chronic poverty of the homeless only magnifies the challenges faced in navigating pregnancy and infant care. 8,10 Homeless mothers not only must raise children while struggling with the previously mentioned barriers, but both mothers and children are at greater risk of experiencing ill health during and after pregnancy.…”

“…3,5,8,10,19 The chronic poverty of the homeless only magnifies the challenges faced in navigating pregnancy and infant care. 8,10 Homeless mothers not only must raise children while struggling with the previously mentioned barriers, but both mothers and children are at greater risk of experiencing ill health during and after pregnancy. 3,[8][9][10]19 Limitations Small sample size and single-site setting may limit this study's generalizability.…”

“…8,10 Homeless mothers not only must raise children while struggling with the previously mentioned barriers, but both mothers and children are at greater risk of experiencing ill health during and after pregnancy. 3,[8][9][10]19 Limitations Small sample size and single-site setting may limit this study's generalizability. Since women's shelter populations are variable and turnover is rapid, we may have captured a nonrepresentative sample.…”

“…Homeless women experience higher rates of domestic violence and other traumatic events and report more chronic stress related to financial and housing instability, all of which have been associated with premature births and lower birth weight. 3,[8][9][10] African American women constitute a disproportionately high percentage of the homeless population, and chronic stress related to racism also has been associated with lower birth weights and more premature births. 2,11,12 Homeless women are more prone to have behavioral and health risk factors that are known to lead to worse birth outcomes.…”

“…For example, homeless women have higher rates of cigarette, alcohol, and illicit drug use during pregnancy, and higher risk of being either underweight or overweight. 3,[8][9][10]12 These personal health risk factors can lead to infants with lower birth weights and more maternal and infant complications during birth. Homeless women also tend to have subsequent pregnancies at shorter intervals.…”