May 31, 2023

Accessible Prenatal Imaging Services for Pregnant Patients Experiencing Housing Insecurity

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By Anusha Gandhi, MS3, Baylor College of Medicine

Anusha GandhiRadiology services are a crucial aspect of effective healthcare that everyone should have access to. It is especially important for radiology advocacy and outreach efforts to pay attention to those who are particularly vulnerable and those who may face additional barriers towards accessing and utilizing key imaging services. One of the many ways through which radiologists can better serve the community is by providing free prenatal ultrasounds to pregnant women experiencing housing insecurity. 

Housing insecurity during the second and third trimester of pregnancy has been shown to be associated with inadequate prenatal care utilization1. Pregnant women facing housing insecurity often face barriers to accessing prenatal care, including lack of transportation, child care and peer support, in addition to varying levels of health literacy and access to material resources and telecommunication2. Prenatal housing insecurity is also an independent risk factor for low birth weight3, preterm delivery4, longer hospital stays5 and increased likelihood of requiring neonatal intensive care5.

Providing and interpreting free prenatal ultrasounds can aid in detecting many conditions that can be medically managed if we are aware of the diagnosis. For example, regular prenatal ultrasounds can help diagnose ectopic pregnancies or multiple gestations, identify abnormalities in placental growth and location or irregularities in fetal growth and development, screen for complications of gestational diabetes and preeclampsia, and identify any fetal anomalies that may require advanced pediatric care to be available at birth. Providing free prenatal screening ultrasounds may also help build trust between patients and providers and establish an entry point for patients into the larger medical system for continued care over time for them and their child. The combination of early diagnosis and the act of connecting these patients with the resources necessary for early intervention can directly improve both maternal and fetal outcomes. In addition to increased healthcare utilization5, unstable housing in pregnant patients has been shown to be associated with higher delivery-related hospital costs4. Additionally, inadequate prenatal care utilization has been shown to increase odds of admission to the neonatal intensive care unit7. Thus, earlier prenatal ultrasound screening could potentially reduce overall healthcare costs and utilization in the long term. For example, early detection and medical management of vasa previa in twin pregnancies has been shown to be cost effective6.

Programs such as San Francisco’s Homeless Prenatal Program8 and Houston State of Health’s Homeless Prenatal Program9 have started such initiatives to provide support and resources to expecting mothers experiencing housing insecurity. Radiologists can play an even larger part and participate in direct and impactful outreach with the potential to significantly improve outcomes. An example of such outreach is through mobile ultrasound vans. In one study, pregnant women using these mobile prenatal services initiated prenatal care three weeks earlier than pregnant women utilizing other services10. By travelling directly to members of underserved communities, we can meet the patient where they are rather than forcing them to navigate their way to available resources. 

As experts in imaging, it is the role of the radiologist to not only provide these imaging services, but also to counsel patients on preventive care and healthy habits during pregnancy to minimize their pregnancy-related risks. Ultimately, radiologists have the privilege of being able to identify and diagnose conditions upstream, at the very point of imaging. Pregnant women facing housing insecurity are a particularly vulnerable population. Accessible, free prenatal imaging services could help mitigate barriers faced by this population by initiating prenatal care earlier on, identifying high-risk pregnancies, and allowing patients to be connected to the appropriate resources.

References

  1. Richard, E., Vuillermoz, C., Lioret, .S, et al. Social determinants of inadequate prenatal care utilization in sheltered homeless mothers in the Greater Paris area in France. Front Public Health. 2023;11:1080594. doi:10.3389/fpubh.2023.1080594
  2. Ake, T., Diehr, S., Ruffalo, L., et al. Needs Assessment for Creating a Patient-Centered, Community-Engaged Health Program for Homeless Pregnant Women. J Patient-Centered Res Rev. 2018;5(1):36–44. doi:10.17294/2330-0698.1591
  3. Cutts, D.B., Coleman, S., Black, M.M., et al. Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes. Matern Child Health J. 2015;19(6):1276–1283. doi:10.1007/s10995-014-1633-6
  4. Yamamoto, A., Gelberg, L., Needleman, J., et al. Comparison of Childbirth Delivery Outcomes and Costs of Care Between Women Experiencing vs Not Experiencing Homelessness. JAMA Netw Open. 2021;4(4):e217491. doi:10.1001/jamanetworkopen.2021.7491
  5. Richards, R., Merrill, R.M., Baksh, L. Health Behaviors and Infant Health Outcomes in Homeless Pregnant Women in the United States. Pediatrics. 2011;128(3):438–446. doi:10.1542/peds.2010-3491
  6. Cipriano, L., Barth Jr., W., Zaric, G. The cost-effectiveness of targeted or universal screening for vasa praevia at 18–20 weeks of gestation in Ontario. BJOG Int J Obstet Gynaecol. 2010;117(9):1108–1118. doi:10.1111/j.1471-0528.2010.02621.x
  7. Manjavidze, T., Rylander, C., Skjeldestad, F.E., Kazakhashvili, N., Anda, E.E. The impact of antenatal care utilization on admissions to neonatal intensive care units and perinatal mortality in Georgia. PLoS ONE. 2020;15(12):e0242991. doi:10.1371/journal.pone.0242991
  8. Homeless Prenatal Program. Accessed April 27, 2023. https://homelessprenatal.org/
  9. Portal HPHD. Houston Public Health Data Portal :: Promising Practices :: Homeless Prenatal Program. Accessed April 27, 2023. https://www.houstonstateofhealth.com/promisepractice/index/view?pid=3504
  10. Edgerley, L.P., El-Sayed, Y.Y., Druzin, M.L., Kiernan, M., Daniels, K.I. Use of a Community Mobile Health Van to Increase Early Access to Prenatal Care. Matern Child Health J. 2007;11(3):235–239. doi:10.1007/s10995-006-0174-z