Eviction during a pregnancy is dangerous for women and newborns

(HealthDay)—Being pregnant triggers a lot of feelings. For many, there is joy, expectation and sometimes a little nervousness about what's to come.

Yet not all pregnant women start this journey on the same footing, and for some, such as those who are facing eviction while pregnant, there's a tremendous amount of stress.

That prenatal stress is associated with lower infant birth weight, gestational age, prematurity and even infant mortality, according to a new study that looked at the association between evictions during pregnancy and adverse birth outcomes.

"I think birth outcomes are such an important outcome to look at because there's so much research documenting just how important these are for your health outcomes across your entire life. Not just your health at birth, but later in life, your educational outcomes, your occupational outcomes," said study author Gracie Himmelstein. She is a Ph.D. candidate at Princeton University and MD candidate at Icahn School of Medicine at Mount Sinai, in New York City.

"We know that infant health is transmitted to subsequent generations. If you are born low birth weight, your children are then more likely to be born with low birth weight," Himmelstein explained.

More than 2.3 million U.S. households were served with eviction notices in 2016 and almost 900,000 people were evicted from their homes, according to background information in the study. Eviction rates could increase due to the economic impact of the COVID-19 pandemic.

The new study compared birth outcomes of infants in Georgia whose mothers were evicted during gestation with those who were evicted at other times, from January 2000 through December 2016.

The researchers identified 88,862 births to 45,122 mothers who experienced a total of 99,517 evictions during the study period. This included 10,135 births to women who had an eviction during pregnancy.

Comparing the women who had an eviction during pregnancy with those who were evicted at other times, the investigators found that eviction during pregnancy was associated with negative consequences.

Each year in the United States, about 6% of renters experience an eviction filing, Himmelstein said. It's a major stressful event that can include issues getting to work, problems accessing food and child care, moving to poorer neighborhoods and doing more physically demanding work, which may also be detrimental to pregnancies, she explained.

Himmelstein suggested there could be a cascade of evictions in the United States because of the economic displacement of the past year due to the pandemic and the eventual end of eviction moratoriums.

"Often when people think of evictions, they think of the sheriff coming and removing your possessions from the home, but that actually is just one end of the spectrum," Himmelstein said. "Many tenants just move after hearing that an eviction has been filed against them before the court ever makes any judgment. So, even just this threat that you could possibly be evicted is a major event in people's lives."

Though the study shows an association, and not necessarily cause and effect, it is consistent with what is already known about the long-term effects of maternal stress on fetuses, said Dr. Andrew Garner. He is a primary care pediatrician with Partners in Pediatrics in Westlake, Ohio, and a member of the American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health.

It's important to understand what drives these outcomes, but also not to blame the mothers, Garner said.

"The evictions are not destiny. And I think that's always the trade-off in these sorts of studies is we're trying to raise awareness that if you want to improve the child's health, you need to help the parents, but in doing so you have to make it clear that it's not necessarily the parents' fault," Garner said.

Even if a mother does experience eviction or other stress during her pregnancy, it is possible to override the impact of some of those outcomes. Interventions include breastfeeding and more time spent caressing the infant, Garner noted.

"If we are able to, for example, implement policies like prolonged maternal leave and family medical leaves so that the moms actually have longer times to bond with their kids before going back to work and to make that attachment, those safe, stable, nurturing relationships early on we know can reverse a lot of those trends and we can see reversing the effects of stress at the molecular level," Garner said.

An editorial that accompanied the study published online recently in JAMA Pediatrics noted that evictions are not evenly distributed throughout the U.S. population. Low-income women of color, especially Black women, are at heightened risk for eviction, the editorial said.

The study concluded that ensuring housing, social and medical assistance to pregnant women at risk for eviction may improve infant health.

Himmelstein said, "I think we hope that by demonstrating the full scope of the consequences here, that can serve as sort of a piece of evidence for policy makers, that this is an important issue and one that deserves significant attention."

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