Food & Housing Insecurity Influence on Outcomes in Pregnant Patients with Substance Use Disorder (SUD)

Small studies have suggested a negative influence of food insecurity on NAS severity in women with SUD. The objective of this study is to evaluate the influence of food and housing insecurity (HI and FI) on maternal and neonatal outcomes in women with SUD. Consenting patients followed in a cohort study of pregnant persons receiving care through a multispecialty program between 2015 and 2021. Housing was assessed by, “Do you have housing?” on enrollment with assessment of living situation. A validated two-question Hunger Vital Sign food insecurity screen was also utilized for a subset of patients. Maternal and neonatal outcomes were related to these risk profiles. Fisher’s exact test was used in analysis of variables. 401 patients responded regarding HI. 186 (46%) claimed their own residence, and 72 in residential treatment (18%). 118 lived at someone else's (29%) while 26 (6.5%) had no housing at time of enrollment (7 on streets, 5 in shelters, 2 in institutions, and 10 other). HI was considered a risk for the later 143 patients. Demographics noted patients with HI were significantly younger and more frequently of black race. ACE scores were significantly higher in women with HI, 4.73±2.5 vs 3.67±2.8, P=.005. Gestational age at delivery was similar between groups. Rates of NICU admission however were significantly increased with HI, 111 (80%) vs 180 (71%), P=.04. NAS treatment and neonatal length of stay did not differ. Neonatal disposition to a relative or foster care was greater with HI at enrollment, 38% vs 30%, P=.01. 68 patients completed the recently added FI questionnaire with 45 (66%) reporting FI at enrollment. An Edinburgh score ≥12 was more common in those with FI (28 (68%) vs 10 (44%), P=.05, Table 2. FI and HI are common in women with SUD. Patients with HI were at higher risk for toxic stress, more frequently required NICU admission, and more likely did not have custody of their child at discharge.View Large Image Figure ViewerDownload Hi-res image Download (PPT)