Homelessness During Pregnancy: A Unique, Time-Dependent Risk Factor of Birth Outcomes Diana B. CuttsSharon ColemanMaureen M. BlackMariana M. Chilton • John T. CookStephanie Ettinger de CubaTimothy C. Heeren • Alan MeyersMegan SandelPatrick H. CaseyDeborah A. Frank

Springer Science+Business Media New York 2014 Abstract Evaluate homelessness during pregnancy as a unique, time-dependent risk factor for adverse birth out- comes. 9,995 mothers of children\48 months old surveyed at emergency departments and primary care clinics in five US cities. Mothers were classified as either homeless during pregnancy with the index child, homeless only after the index child's birth, or consistently housed. Outcomes included birth weight as a continuous variable, as well as categorical outcomes of low birth weight (LBW;\2,500 g) and preterm delivery (\37 weeks). Multiple logistic regression and adjusted linear regression analyses were performed, com- paring prenatal and postnatal homelessness with the referent group of consistently housed mothers, controlling for maternal demographic characteristics, smoking, and child age at interview. Prenatal homelessness was associated with higher adjusted odds of LBW (AOR 1.43, 95 % CI 1.14, 1.80, p \ 0.01) and preterm delivery (AOR 1.24, 95 % CI 0.98, 1.56, p = 0.08), and a 53 g lower adjusted mean birth weight (p = 0.08). Postnatal homelessness was not associ- ated with these outcomes. Prenatal homelessness is an independent risk factor for LBW, rather than merely a mar- ker of adverse maternal and social characteristics associated with homelessness. Targeted interventions to provide hous- ing and health care to homeless women during pregnancy may result in improved birth outcomes.