. 2019 Oct 28;16(21):4154.

doi: 10.3390/ijerph16214154.

Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM_2.5 on Birthweight

Jongeun Rhee¹, M Patricia Fabian², Stephanie Ettinger de Cuba³, Sharon Coleman⁴, Megan Sandel^{5

6}, Kevin James Lane⁷, Maayan Yitshak Sade⁸, Jaime E Hart^{9

10}, Joel Schwartz^{11

12

13}, Itai Kloog¹⁴, Francine Laden^{15

16

17}, Jonathan I Levy¹⁸, Antonella Zanobetti¹⁹

Affiliations

¹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. jerhee@mail.harvard.edu.
² Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. PFABIAN@bu.edu.
³ Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118, USA. sedc@bu.edu.
⁴ Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, MA 02118, USA. sharcole@bu.edu.
⁵ Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118, USA. megan.sandel@bmc.org.
⁶ Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA. megan.sandel@bmc.org.
⁷ Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. klane@bu.edu.
⁸ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. myitshak@hsph.harvard.edu.
⁹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. rejch@channing.harvard.edu.
¹⁰ Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. rejch@channing.harvard.edu.
¹¹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹² Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹³ Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹⁴ Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel. ikloog@bgu.ac.il.
¹⁵ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁶ Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁷ Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁸ Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. jonlevy@bu.edu.
¹⁹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. azanobet@hsph.harvard.edu.

PMID: 31661898
PMCID: PMC6862522
DOI: 10.3390/ijerph16214154

Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM_2.5 on Birthweight

Jongeun Rhee et al. Int J Environ Res Public Health. 2019.

. 2019 Oct 28;16(21):4154.

doi: 10.3390/ijerph16214154.

Authors

Affiliations

¹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. jerhee@mail.harvard.edu.
² Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. PFABIAN@bu.edu.
³ Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118, USA. sedc@bu.edu.
⁴ Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, MA 02118, USA. sharcole@bu.edu.
⁵ Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118, USA. megan.sandel@bmc.org.
⁶ Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA. megan.sandel@bmc.org.
⁷ Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. klane@bu.edu.
⁸ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. myitshak@hsph.harvard.edu.
⁹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. rejch@channing.harvard.edu.
¹⁰ Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. rejch@channing.harvard.edu.
¹¹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹² Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹³ Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. joel@hsph.harvard.edu.
¹⁴ Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel. ikloog@bgu.ac.il.
¹⁵ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁶ Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁷ Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. fladen@hsph.harvard.edu.
¹⁸ Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02115, USA. jonlevy@bu.edu.
¹⁹ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA. azanobet@hsph.harvard.edu.

PMID: 31661898
PMCID: PMC6862522
DOI: 10.3390/ijerph16214154

Abstract

Few studies examined the impact of maternal socioeconomic status and of its combined effects with environmental exposures on birthweight. Our goal was to examine the impact of maternal homelessness (mothers ever homeless or who lived in shelters during pregnancy) and participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy in conjunction with air pollution exposure on birthweight in the Boston-based Children's HealthWatch cohort from 2007 through 2015 (n = 3366). Birthweight was obtained from electronic health records. Information on maternal homelessness and WIC participation during pregnancy were provided via a questionnaire. Prenatal fine particulate matter (PM_2.5) exposures, estimated at the subject's residential address, were calculated for each trimester. We fit linear regression models adjusting for maternal and child characteristics, seasonality, and block-group-level median household income and examined the interactions between PM_2.5 and each covariate. Prenatal maternal homelessness was associated with reduced birthweight (-55.7 g, 95% CI: -97.8 g, -13.7 g), while participating in WIC was marginally associated with increased birthweight (36.1 g, 95% CI: -7.3 g, 79.4 g). Only average PM_2.5 during the second trimester was marginally associated with reduced birthweight (-8.5 g, 95% CI: -19.3, 2.3) for a 1 µg/m³ increase in PM_2.5. The association of PM_2.5 during the second trimester with reduced birthweight was stronger among non-Hispanic Black mothers and trended toward significance among immigrants and single mothers. Our study emphasizes the independent and synergistic effects of social and environmental stressors on birthweight, particularly the potentially protective effect of participating in WIC for vulnerable populations.

Keywords: PM2.5; birthweight; maternal homelessness; maternal socioeconomic status; supplemental nutrition programs.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Number of Boston-based Children’s HealthWatch study subjects excluded from the final analytical sample.

**Figure 2**
Change in birthweight (g) for a 1 µg/m³ increase in the average PM_2.5 during the 1st, 2nd, and 3rd pregnancy trimesters, for prenatal homelessness, and for the participation status in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in the Boston-based Children’s HealthWatch cohort (N = 3366). Note: Adjusted for maternal age, body mass index (BMI), race/ethnicity, nativity, education, smoking history, insurance, marital status, child gestational age and sex, seasonality, and median household income.

**Figure 3**
Change in birthweight (g) for a 1 µg/m³ increase in the average PM_2.5 during the 2nd trimester, stratified by maternal and child characteristics in the Boston-based Children’s HealthWatch cohort.

See this image and copyright information in PMC

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Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM_2.5 on Birthweight

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Effects of Maternal Homelessness, Supplemental Nutrition Programs, and Prenatal PM_2.5 on Birthweight

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