Eviction Ups Risk of Low Infant Birth Weight and Prematurity

Mothers who received an eviction notice during pregnancy had a higher risk of adverse birth outcomes, according to a case-control study based in Georgia.

Compared to mothers who received an eviction filing outside of pregnancy, those who received notice while pregnant had infants with lower birthweight (mean difference -26.88 g, 95% CI −39.53 to 14.24) and gestational age (mean difference -0.9 weeks, 95% CI −0.16 to −0.03), reported MD-PhD candidate Gracie Himmelstein and Matthew Desmond, PhD, of Princeton University.

Infants born to mothers evicted while pregnant had increased rates of low birthweight (0.88 percentage points, 95% CI 0.23-1.54) and prematurity (1.14 percentage points, 95% CI 0.21-2.06), the researchers wrote in JAMA Pediatrics.

Himmelstein and Desmond found that the association between eviction and birthweight was strongest in the second and third trimester, underscoring how changes in maternal behavior, disruptions in prenatal care, and increased maternal stress in the later stages of pregnancy impacts newborn health.

“We see that eviction during pregnancy has these detrimental effects on birth outcomes,” Himmelstein told MedPage Today. As this study compared mothers evicted during pregnancy to those evicted at different times, she said, it was significant to see that findings remained significant across sub-groups, including race, education level, and marital status.

“There was a consistency throughout,” she said. “Regardless of who you were, eviction during pregnancy was bad for your infant’s health.” This finding was significant considering that Black mothers typically face higher rates of adverse birth outcomes, Himmelstein stated, noting that higher rates of birth outcomes in that population may not have driven these findings.

In an accompanying editorial, Erika Cordova-Ramos, MD, of Boston University School of Medicine, and two colleagues stated that the most meaningful insight to these findings comes from the understanding that eviction is not evenly distributed across demographic groups. Low-income women of color, and especially Black women, experience greater rates of both eviction and suboptimal birth outcomes.

“According to the data presented, eviction may have exaggerated consequences on birth outcomes among Black compared with White families,” Cordova-Ramos and colleagues wrote. These “stacking inequalities” are likely the result of systemic social injustice, they added, stating that interventions could possibly advance multigenerational health equity.

While this study was strong in its attenuation of potential bias by comparing evicted pregnant people to those evicted at different times, the editorialists cautioned that it couldn’t establish causality. However, public health officials could use the findings to better understand how to serve housing-insecure patients and ultimately improve infant health.

More than 2.3 million people in the U.S. were served with eviction notices in 2016, and 900,000 were removed from their homes, Himmelstein and Desmond wrote. Economic dislocation from the COVID-19 pandemic has brought a new urgency to understanding the impact of eviction on health outcomes, as acute stress and disruptions in care may have widespread health impacts.

Himmelstein and Desmond investigated the association between evictions and adverse birth outcomes, using data that linked court records to birth data in the state of Georgia. They included all eviction notices — even those that did not result in an eviction judgment — and births that occurred from 2000 to 2016. The study authors compared mothers evicted outside of pregnancy to those who received notice while pregnant.

The final analysis included nearly 89,000 singleton births to some 45,000 mothers. About 10,000 mothers received eviction notices during their pregnancy, while such notices were received by nearly 79,000 outside of pregnancy. Close to three-quarters of mothers evicted during pregnancy were Black.

Eviction actions had the strongest link with birthweight in the second and third trimesters, the time period when most fetal weight gain occurs. An eviction during the second trimester was associated with a birthweight reduction of 34.74 g (95% CI −57.51 to −11.97), and 35.80 g (95% CI −52.91 to −18.69) in the third trimester.

In addition to higher rates of low birthweight and prematurity, infant mortality was numerically greater when mothers were evicted while pregnant, but this finding was not statistically significant.

Hospital systems could play a part in ameliorating adverse effects from evictions, Himmelstein and Desmond noted, through programs to promote housing stability. These could include providing rent support, investing in affordable housing, and creating partnerships that integrate legal services into medical care.

“As opposed to some of these other forms of maternal disadvantage, such as poverty, eviction is discreet, tactical, and responsive to policy intervention,” Himmelstein told MedPage Today. “We know that this is a lever that can be used to make interventions in birth outcomes.”

That the analysis included eviction notices not resulting in actual loss of housing was a potential limitation. Additionally, the control group may have suffered consequences during pregnancy from prior eviction notices, which would bias results toward the null.