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Homelessness in Pregnancy and Increased Risk of Adverse Outcomes: A Retrospective Cohort Study

Gilmore, Emma; Duncan, Karen; Ades, Veronica
Limited data indicates that homelessness during pregnancy is linked to adverse outcomes for both mothers and newborns, but there is an information gap surrounding pregnant individuals struggling with homelessness. In a landscape of increasing healthcare disparities, housing shortages and maternal mortality, information on this vulnerable population is fundamental to the creation of targeted interventions and outreach. The current study investigates homelessness as a risk factor for adverse obstetrical, neonatal, and postpartum outcomes. We reviewed more than 1000 deliveries over 1 year at a large public hospital in New York City, comparing homeless subjects to a group of age-matched, stably housed controls. Multiple outcomes were assessed regarding obstetrical, neonatal, and postpartum outcomes along with social stressors. Homeless pregnant individuals were more likely to experience numerous adverse outcomes, including cesarean delivery and preterm delivery. Their neonates were more likely to undergo an extended stay in the intensive care unit and evaluation by the Administration for Children's Services, suggesting that they may be at an increased risk for family separation. After delivery, patients were less likely to exclusively breastfeed or return for their postpartum visit. Regarding personal history, they were more likely to endorse a history of violence or abuse, use illicit substances, and carry a psychiatric diagnosis. These findings indicate that homelessness is linked to numerous adverse obstetrical, neonatal, and postpartum outcomes that worsen health indices and exacerbate pre-existing disparities. Initiatives must focus on improved outreach and care delivery for homeless pregnant individuals.
PMCID:11052971
PMID: 38478248
ISSN: 1468-2869
CID: 5694622

Granulosa-Cell Tumor Diagnosed in the Third Decade of Life in a Patient with Ollier"™s Disease: A Rare But Clinically Important Correlation

Hughes-Hogan, Logan; Popiolek, Dorota; Duncan, Karen; Timor-Tritsch, Ilan E.
SCOPUS:85148667218
ISSN: 1042-4067
CID: 5445772

Proving microcystic ultrasound appearance of borderline ovarian tumors by three-dimensional 'silhouette' rendering

Timor-Tritsch, I E; Monteagudo, A; Popiolek, D A; Duncan, K M; Goldstein, S R
PMID: 35195307
ISSN: 1469-0705
CID: 5172182

Large Uterine, Subserosal Hematoma as a Complication of Dilation and Evacuation Leading to Necrotic Uterine Defect and Delayed Postabortion Hemorrhage

Kreines, Fabiana M.; Duncan, Karen
ISI:000607674900001
ISSN: 1042-4067
CID: 4773852

Match Preparation: Optimizing Success and Satisfaction [Meeting Abstract]

Duncan, Karen M.
ISI:000454042000058
ISSN: 0029-7844
CID: 3575012

Cesarean or vaginal delivery for the breech fetus at the threshold of viability: results from a maternal-fetal medicine specialists survey

Deutsch, Aaron B; Duncan, Karen; Rajaram, Lakshminarayan; Salihu, Hamisu M; Spellacy, William N; Belogolovkin, Victoria
OBJECTIVE: To determine how United States Maternal-Fetal medicine specialists recommend delivery of a breech fetus at the threshold of viability. METHODS: U.S. Society for Maternal-Fetal Medicine (SMFM) members were surveyed about; geographic location, practice type, whether they performed deliveries, definition of threshold for viability, recommendations for delivery of a breech fetus at the threshold of viability, and if the current medical-legal climate had any bearing on their decisions. Chi-Square and Fisher's Exact tests were used for analysis. RESULTS: 510 SMFM members responded to the questionnaire. The highest percentage of respondents stated '23 weeks' (31%) as the cutoff for viability, followed by '24 weeks' (21%) and '23 weeks or 500 g' (10%). Seventy percent recommended cesarean delivery for a breech fetus at the threshold of viability. The majority of respondents based their decision on 'published data' or 'expert opinion', however, 58.6% reported they felt current medical evidence was inadequate to support a recommendation. Fifty-three percent stated their recommendations are affected by medical-legal concerns. CONCLUSION: The majority of U.S. maternal fetal-medicine specialists who responded would recommend cesarean delivery for a breech fetus at the threshold of viability, despite the belief that there is inadequate evidence in the literature to support this recommendation.
PMID: 20807158
ISSN: 1476-4954
CID: 1072032