Homelessness is associated with an increased risk of short interpregnancy intervals (SIPIs), according to a recent study published in JAMA Network Open.
Takeaways
- The study found that homelessness is associated with a higher risk of short interpregnancy intervals (SIPIs), which is defined as a period of less than 18 months between delivery and subsequent pregnancy conception.
- SIPIs are associated with adverse maternal and neonatal outcomes, including preterm birth, maternal mortality, and infant death. This highlights the importance of understanding and addressing factors contributing to SIPIs.
- Race, ethnicity, and socioeconomic status have been identified as factors associated with SIPI disparities. Homelessness, a significant socioeconomic factor, further exacerbates these disparities, particularly among non-Hispanic Black and Hispanic individuals.
- The cohort study analyzed data from various databases, including birth records and homeless service records from Colorado, spanning from 2016 to 2021. The final analysis included 77,494 women with live births, with 636 experiencing homelessness and 76,858 being domiciled.
- The study's findings emphasize the need for targeted interventions addressing SIPIs among homeless women, considering racial and ethnic disparities. Tailored approaches could help mitigate the associated risks and improve maternal and neonatal outcomes.
SIPI describes a period of under 18 months between delivery and subsequent pregnancy conception. Of US mothers, 29% to 35% experience a SIPI, which as associated with increased risks of adverse maternal and neonatal outcomes including preterm birth, maternal mortality, and infant death.
Race, ethnicity, and socioeconomic status have been associated with SIPI disparities. Homelessness is associated with increased risks of pregnancy complications such as preterm birth and neonatal intensive care unit admission, but data evaluating the association between homelessness and SIPI risk has not been evaluated.
To evaluate the association between homelessness and SIPI risk, investigators conducted a cohort study. Databases evaluated included the All Payer Claims Database, Homeless Management Information System, death records, and infant birth records from Colorado. Data from January 1, 2016, to December 31, 2021, was evaluated.
Participants included women with a previous pregnancy resulting in live birth who delivered between 2016 and 2021. Women with a previous pregnancy resulting in termination were excluded from the analysis.
Homelessness, race, and ethnicity were the primary exposures, with homelessness determined by using shelter services 1 or more times during the study period. Women who never used shelter services, defined as domiciled women, composed a control group.
Infant birth certificates were used to determine race and ethnicity.The primary outcome was measured as a binary variable of whether the interpregnancy interval was under 18 months.
There were 77,494 women with live births included in the final analysis, aged a mean 30.7 years. Homelessness was reported in 636 of these women, while 76,858 were domiciled. Of women, 39.3% were Hispanic, 7.3% non-Hispanic Black, 48.4% non-Hispanic White, and 5.1% of another race or ethnicity.
Women experiencing homelessness were more often younger, non-Hispanic Black or Hispanic, and had public insurance compared to domiciled women. These women were less likely to be non-Hispanic White, married, or have a higher education level.
SIPI was reported in 34.7% of women experiencing homelessness compared to 27.5% of domiciled women.Among women experiencing homelessness, the most frequently observed interpregnancy intervals were 6 to 7 months and 22 to 23 months.
Among domiciled women, the most common interval was 14 to 15 months. The adjusted odds ratio (AOR) for SIPI among women experienced homelessness was 1.23.
Interactions between homelessness and race and ethnicity were observed to impact SIPI. A smaller association was reported in non-Hispanic Black individuals and non-Hispanic White individuals when compared to Hispanic individuals, with AORs of 0.59 and 0.57, respectively.
These results indicated an association between homelessness and SIPI. Investigators recommended racial and ethnic disparities be considered when designing interventions.
Reference
Sakai-Bizmark R, Jackson NJ, Wu F, et al. Short interpregnancy intervals among women experiencing homelessness in Colorado. JAMA Netw Open. 2024;7(1):e2350242. doi:10.1001/jamanetworkopen.2023.50242
