459: Unstable housing is linked to adverse obstetric outcomes

To investigate relationship between unstable housing and obstetric outcomes. Data were drawn from a database of liveborn neonates linked to their mothers’ hospital discharge records (2007- 2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age (GA) of 20-44 weeks (N=2,963,888). Women with unstable housing (“lack of housing” or “inadequate housing”) were identified using ICD-9 codes from hospital discharge records. Outcomes of interest included preterm birth (PTB, <37 weeks GA), early term birth (37-38 weeks GA), preterm labor (PTL), preterm premature rupture of membranes (PPROM), pre-eclampsia, chorioamnionitis, extended hospitalization after delivery (vaginal birth >2 days; cesarean >4 days), emergency department (ED) visit within 1 year after delivery, and readmission within 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare to the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, BMI, smoking, drug/alcohol dependence, hypertension, diabetes, mental health disorder, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression. 2,794 women with unstable housing were identified, and 85% (N=2,386) had an exact propensity score match. Compared with matched controls, women with unstable housing were at higher odds of PTL (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.1-1.4), PPROM (OR 1.3, 95% CI 1.0-1.6, p < 0.05), long hospitalization (OR 1.7, 95% CI 1.5-1.9), an ED visit (OR 2.6, 95% CI 2.3-2.9), and readmission (OR 3.1, 95% CI 2.7-3.7, Figure 1). Although women with unstable housing were not at elevated odds of PTB or early term birth, the rate of PTB was high in both samples (Figure 2). Women with unstable housing were not at higher odds of pre-eclampsia nor chorioamnionitis. Although ICD codes likely underestimate its prevalence, unstable housing is a strong predictor of adverse obstetric outcomes. Interventions to improve housing stability during the prenatal period should be explored.View Large Image Figure ViewerDownload Hi-res image Download (PPT)