No Home for the Cradle

Babies born to homeless mothers begin life with uncertain futures. They are often in poorer health and are more likely to have developmental delays than babies born to families who are not homeless. While it seems obvious these infants would encounter more health issues due to a lack of stable housing, researchers at Boston Medical Center’s Children’s HealthWatch have discovered their disadvantage starts even before birth.

The recent study, published in the journal Pediatrics, gathered data from interviews with more than 20,000 underserved families in Boston, Philadelphia, Minneapolis and Little Rock. The study tracked the responses from three key exposure groups—those who were homeless before the birth of their child, those who became homeless after the birth of their child and those who were homeless for both spans of time. Researchers then compared the health of exposed babies to babies from stably housed families. The results of this cross-sectional analysis showed a significant increase in poor health, developmental delays and hospitalizations in all young children exposed to homelessness; what was shocking was this pattern of adverse health was seen in babies who only experienced homelessness before birth.

“Even after factoring out other prenatal exposures such as marital status, breastfeeding and maternal education level, this study suggests that unborn babies are subjected to severe stress from their homeless mothers that can adversely impact their health after birth and throughout their young life,” explains Megan Sandel, MD, MPH, associate director of the Grow Clinic at BMC and a principal investigator for Children’s HealthWatch.

Stress in pregnancy can physically impact the health of an unborn baby. The term “epigenetics” describes this phenomenon when outside forces such as lifestyle and external stressors can change DNA expression within a developing fetus. Although epigenetics is still in the early stages of discovery, a growing body of evidence associates severe stress with negative health outcomes in infants.

“What I find surprising is that even after these babies are put into stable housing, we still see health impacts of their homelessness such as increased hospitalizations and developmental delays,” adds Sandel. “It is a significant finding that indicates there is no safe level homelessness and further argues the importance of preventing homelessness for at-risk families.”

With a focus on the prevention of homelessness and its detrimental effects, BMC has launched an affordable housing initiative focusing on housing families in Boston and its surrounding communities. Among these initiatives is a new partnership with Metro Housing Boston, a non-profit that connects at-risk families with homelessness prevention resources. Through the partnership, Metro Housing Boston staff will work onsite at the hospital three days a week to help at-risk BMC pediatric families find access to stable housing.

“As our study indicates, a stable home is a foundation to good health. It is our job as a health care organization to link our families with these types of resources to improve birth outcomes and positively impact the health trajectory of children over a lifetime,” concludes Sandel.