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Cited by 68Maternal and Neonatal HealthcareHomelessness and Social IssuesFood Security and Health in Diverse Populations

Association of Eviction With Adverse Birth Outcomes Among Women in Georgia, 2000 to 2016

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Himmelstein, Gracie, Desmond, Matthew·2021·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2020.6550PMC PMC7922232
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Abstract

Importance: More than 2 million families face eviction annually, a number likely to increase due to the coronavirus disease 2019 pandemic. The association of eviction with newborns' health remains to be examined. Objective: To determine the association of eviction actions during pregnancy with birth outcomes. Design: This case-control study compared birth outcomes of infants whose mothers were evicted during gestation with those whose mothers were evicted at other times. Participants included infants born to mothers who were evicted in Georgia from January 1, 2000, to December 31, 2016. Data were analyzed from March 1 to October 4, 2020. Exposures: Eviction actions occurring during gestation. Main Outcomes and Measures: Five metrics of neonatal health included birth weight (in grams), gestational age (in weeks), and dichotomized outcomes for low birth weight (LBW) (<2500 g), prematurity (gestational age <37.0 weeks), and infant death. Results: A total of 88 862 births to 45 122 mothers (mean [SD] age, 26.26 [5.76] years) who experienced 99 517 evictions were identified during the study period, including 10 135 births to women who had an eviction action during pregnancy and 78 727 births to mothers who had experienced an eviction action when not pregnant. Compared with mothers who experienced eviction actions at other times, eviction during pregnancy was associated with lower infant birth weight (difference, -26.88 [95% CI, -39.53 to 14.24] g) and gestational age (difference, -0.09 [95% CI, -0.16 to -0.03] weeks), increased rates of LBW (0.88 [95% CI, 0.23-1.54] percentage points) and prematurity (1.14 [95% CI, 0.21-2.06] percentage points), and a nonsignificant increase in mortality (1.85 [95% CI, -0.19 to 3.89] per 1000 births). The association of eviction with birth weight was strongest in the second and third trimesters of pregnancy, with birth weight reductions of 34.74 (95% CI, -57.51 to -11.97) and 35.80 (95% CI, -52.91 to -18.69) g, respectively. Conclusions and Relevance: These findings suggest that eviction actions during pregnancy are associated with adverse birth outcomes, which have been shown to have lifelong and multigenerational consequences. Ensuring housing, social, and medical assistance to pregnant women at risk for eviction may improve infant health.

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  • Chronic housing instability reflects sustained environmental stress associated with prolonged activation of stress-responsive physiological systems.

    “Chronic housing instability reflects sustained environmental stress associated with prolonged activation of stress-responsive physiological systems.”

    From Epigenetic changes associated with multi-generational trauma: characterization, mechanisms, and therapeutics (2026) · cites this paper as [79]

    The Introduction (page unavailable) calls the threat of eviction acutely stressful, and the Discussion (page unavailable) says maternal stress may alter neuroendocrine responses. The Limitations section describes renters’ chronic precarity, but the paper does not say that chronic housing instability causes sustained stress or prolonged activation of physiological systems. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Maternal exposure to eviction has been associated with altered fetal growth and shortened gestation, suggesting disruption of placental, metabolic, and endocrine regulation.

    “Maternal exposure to eviction has been associated with altered fetal growth and shortened gestation, suggesting disruption of placental, metabolic, and endocrine regulation (79).”

    From Epigenetic changes associated with multi-generational trauma: characterization, mechanisms, and therapeutics (2026) · cites this paper as [79]

    The Results report that eviction during pregnancy was associated with lower birth weight and shorter gestation. The Discussion proposes altered maternal neuroendocrine responses as one possible pathway, but the paper does not establish disruption of placental or metabolic regulation, or measure those mechanisms. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Himmelstein, G., & Desmond, M.
Affiliations
Princeton University (US)
Corresponding author
Himmelstein, Gracie
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2021-05-01
Volume
175
Issue
5
Pages
494
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2020.6550
PMC
PMC7922232
OpenAlex
W3133645344
Cited by
68
References
1
Citations by year
2026: 7 · 2025: 8 · 2024: 15 · 2023: 16 · 2022: 16 · 2021: 6
FWCI
14.89
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Health Sciences › Health Professions › General Health Professions › Food Security and Health in Diverse Populations
Keywords
eviction, birth outcomes, low birth weight, preterm birth, infant mortality, birth weight, gestational age, housing insecurity, maternal health, Georgia, United States, COVID-19 pandemic, social determinants of health, eviction moratorium, rental assistance
MeSH terms
COVID-19, Adult, Family Characteristics, Female, Georgia, Housing, Humans, Infant, Infant Welfare, Infant, Newborn, Maternal Welfare, Poverty, Pregnancy, Pregnancy Outcome, Public Health, Public Housing, Case-Control Studies, Vulnerable Populations

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