Born into homelessness: A retrospective observational study

Abstract

Objective: To evaluate the differences in the antenatal and neonatal courses of maternal-infant dyads within a homeless population as compared to the general hospital population.

Design: This was a retrospective observational study.

Setting: A large single tertiary maternity hospital (8500 deliveries/year) in Ireland.

Patients: We retrospectively reviewed perinatal outcomes for homeless women who delivered liveborn infants at a tertiary maternity hospital, during the calendar year 2020. Homelessness was defined as either A) A designated homeless accommodation service listed as the home address; or B) Self-identified as homeless with an address other than homeless accommodation. We then compared the study cohort with the general hospital population who delivered liveborn infants in the year 2020.

Outcome measure: A set of key clinical variables (maternal, antenatal, birth and postnatal outcomes) were obtained and descriptive statistics were performed and compared to available hospital wide data.

Results: A total population of 145 infants born to 143 homeless mothers were included. Compared with the general hospital population, infants born into homelessness were more likely to be born preterm (15 % vs 7 %), with lower median birth weight (3.1 kg vs 3.4 kg) and higher rates of admission to the neonatal unit (35 % vs 14 %). Following discharge, there was a greater incidence of missed appointments to the neonatal clinic (29 % vs 8 %), and lower rates of exclusive breastfeeding (16 % vs 45 %).

Conclusions: Addressing societal inequalities starts before birth. Infants born into homelessness are particularly vulnerable to perinatal factors associated with negative long-term outcomes when compared with the general population.

Keywords: Health Equity; Homelessness; Neonatology; Obstetrics.