Homelessness Contributes To Pregnancy Complications

UMMS Affiliation

Commonwealth Medicine; Department of Family Medicine and Community Health; Department of Quantitative Health Sciences; Center for Health Law and Economics

Publication Date


Document Type



Behavioral Medicine | Female Urogenital Diseases and Pregnancy Complications | Health Services Administration | Health Services Research | Maternal and Child Health | Mental Disorders


Homelessness during pregnancy poses significant health risks for mothers and infants. As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy. We linked data about emergency shelter enrollees with Massachusetts Medicaid claims for the period January 1, 2008-June 30, 2015 to compare health care use and pregnancy complications for 9,124 women who used emergency shelter with those for 8,757 similar women who did not. Rates of mental illness and substance use disorders were significantly higher among homeless women. Adjusted odds of having nine pregnancy complications were also significantly higher for homeless women and remained substantially unchanged after we adjusted for behavioral health disorders. Emergency shelter users also had fewer ambulatory care visits and more months without billable care and were more likely to visit an emergency department. Homelessness and behavioral health disorders appear to be independent factors contributing to pregnancy complications and should be addressed simultaneously.


pregnancy, homelessness, health risks, emergency shelters, mental illness, substance use disorders, pregnancy complications, Health conditions, Access and use, Drug use, Emergency departments, Behavioral health care, Depression, Health care providers, Medicaid, Medical education

DOI of Published Version



Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness Contributes To Pregnancy Complications. Health Aff (Millwood). 2019 Jan;38(1):139-146. doi: 10.1377/hlthaff.2018.05156. PubMed PMID: 30615521.

Journal/Book/Conference Title

Health affairs (Project Hope)

Related Resources

Link to article in PubMed

PubMed ID