Prenatal homelessness, food insecurity, and unemployment and adverse infant outcomes in a California cohort, 2007–2020

Characterize the relationship between infant outcomes and prenatal homelessness, food insecurity and unemployment.

California live births between 22- and 44-weeks’ gestation comprised 6,089,327 pregnancies (2007–2020). Data were collected from linked Vital Statistics and hospital discharge records. Prenatal homelessness, food insecurity, and unemployment were classified as health-related social needs (HRSN) using International Classification of Disease codes in delivery records. Risk ratios for preterm birth, low birthweight, small for gestational age, neonatal intensive care unit admission, emergency department admission, rehospitalization, and death were estimated using log-linear Poisson regression adjusted for birthing person race, payer, and education.

65.7 per 100,000 births had HRSN. These infants had a higher risk of preterm birth (aRR 2.7), low birthweight (aRR 2.7), SGA (aRR 1.5), NICU admission (aRR 3.5), and death (aRR 3.0).

HRSN increase the risk of infant morbidity and mortality but remain underreported in administrative records, making definitive conclusions difficult.