Review of research on residential mobility during pregnancy: consequences for assessment of prenatal environmental exposures

Abstract

Studies on environmental exposures during pregnancy often have limited residential history (e.g., at delivery), potentially introducing exposure misclassification. We reviewed studies reporting residential mobility during pregnancy to summarize current evidence and discuss research implications. A meaningful quantitative combination of results (e.g., meta-analysis), was infeasible owing to variation in study designs. Fourteen studies were identified, of which half were from the US. Most were case-control studies examining birth defects. Residential history was typically assessed after delivery. Overall mobility rates were 9-32% and highest in the second trimester. Mobility generally declined with age, parity, and socioeconomic status, although not consistently. Married mothers moved less frequently. Findings were dissimilar by race, smoking, or alcohol use. On the basis of the few studies reporting distance moved, most distances were short (median often <10 km). Results indicate potential misclassification for environmental exposures estimated with incomplete residential information. This misclassification could be associated with potential confounders, such as socioeconomics, thereby affecting risk estimates. As most moves were short distances, exposures that are homogenous within a community may be well estimated with limited residential data. Future research should consider the implications of residential mobility during pregnancy in relation to the exposure's spatial heterogeneity and factors associated with the likelihood of moving and distance moved.

Figure 1

Percent of mothers who moved during pregnancy and by trimester. Based on control study subjects for case-control studies.^– Based on cases only (subjects with birth defects).^– Mobility during pregnancy from first prenatal visit to delivery rather than conception to delivery.

Figure 2

Percent of mothers who moved during pregnancy, by race/ethnicity. Based on control study subjects for case-control studies.^,,, Based on cases only (subjects with birth defects).^, Black specified as non-Hispanic black; white specified as non-Hispanic White. Some studies also presented results for a category of “Other.”