Riesgos intrínsecos para las mujeres embarazadas en situación de calle
una revisión de alcance
DOI:
https://doi.org/10.5712/rbmfc20(47)4099Palabras clave:
Mujeres embarazadas, Personas sin hogar, Salud materno-infantil, Factores de riesgo, Revisión de alcance, Políticas públicasResumen
Introducción: Las mujeres embarazadas en situación de calle enfrentan un desafío global con consecuencias negativas para madres e hijos, incluyendo embarazos no planificados, explotación sexual, complicaciones en la salud reproductiva y partos prematuros. La falta de acceso a servicios básicos de salud y el estrés derivado de la falta de vivienda afectan adversamente el desarrollo fetal y pueden conducir a enfermedades crónicas. Dada la complejidad y heterogeneidad de la literatura sobre el tema, es necesaria una revisión de alcance para mapear la evidencia existente, identificar lagunas y sintetizar los riesgos que enfrenta esta población vulnerable. Objetivo: Identificar y mapear los factores de riesgo asociados a las mujeres embarazadas en situación de calle y las principales consecuencias para la salud materna y fetal descritas en la literatura científica reciente. Métodos: Se realizó una revisión de alcance en las bases de datos PubMed y SciELO, utilizando los descriptores “Pregnancy”, “Homelessness” y “Risk”. La búsqueda se realizó entre febrero y marzo de 2023, incluyendo artículos publicados en los últimos 10 años (2013–2023) que abordaran riesgos pregestacionales y consecuencias postgestacionales. Se realizó un análisis de contenido temático de los 30 artículos seleccionados para identificar y categorizar los principales riesgos y resultados. Resultados: El análisis temático de los 30 artículos reveló tres ejes principales: atención prenatal, salud de la gestante y parto/postparto. Los hallazgos indican una alta prevalencia de embarazos no planificados, exposición a la violencia sexual y uso de sustancias como riesgos pregestacionales. Durante el embarazo, destacan los desafíos en salud mental, el acceso limitado (aunque variable) a la atención prenatal y las comorbilidades. Los resultados incluyen mayores riesgos de parto prematuro, bajo peso al nacer y complicaciones neonatales. El análisis cuantitativo de la frecuencia de los temas mostró una mayor concentración de estudios sobre la salud de la gestante. Conclusiones: Las mujeres embarazadas en situación de calle enfrentan múltiples riesgos interconectados que impactan negativamente la salud materno-fetal. La revisión evidencia la necesidad de políticas públicas e intervenciones que aborden los determinantes socio-estructurales, mejoren el acceso a la atención de salud sexual y reproductiva y ofrezcan apoyo psicosocial. La falta de datos oficiales en Brasil es una limitación importante. Estudios futuros deben centrarse en la eficacia de las intervenciones y en datos longitudinales.
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Assegid DT, Abera L, Girma M, Hailu M, Tefera B. Pregnancy and sexual related problems among women living on the street in dire Dawa City, Eastern Ethiopia, 2021: qualitative study. BMC Womens Health. 2022;22(1):429. https://doi.org/10.1186/ s12905-022-02006-3 DOI: https://doi.org/10.1186/s12905-022-02006-3
Misganaw AC, Worku YA. Assessment of sexual violence among street females in Bahir-Dar town, North West Ethiopia: a mixed method study. BMC Public Health. 2013;13:825. https://doi.org/10.1186/1471-2458-13-825 DOI: https://doi.org/10.1186/1471-2458-13-825
Paisi M, March-McDonald J, Burns L, Snelgrove-Clarke E, Withers L, Shawe J. Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review. BMJ Sex Reprod Health. 2021;47(3):211-20. https://doi.org/10.1136/bmjsrh-2020-200799 DOI: https://doi.org/10.1136/bmjsrh-2020-200799
Santana CS, Freitas ILS, Mesquita KSF, Araújo BRO, Melo MGB, Almeida AVA. Assistência de enfermagem à mulher em situação de rua no ciclo gravídico-puerperal: uma revisão de literatura. Cad Grad Ciênc Biol Saúde Unit. 2019;5(2):71-82.
Cheng T, Johnston C, Kerr T, Nguyen P, Wood E, DeBeck K. Substance use patterns and unprotected sex among street- involved youth in a Canadian setting: a prospective cohort study. BMC Public Health. 2015;16:4. https://doi.org/10.1186/ s12889-015-2627-z DOI: https://doi.org/10.1186/s12889-015-2627-z
Sandel M, Sheward R, Cuba SE, Coleman SM, Heeren T, Black MM, et al. Timing and duration of pre- and postnatal homelessness and the health of young children. Pediatrics. 2018;142(4):e20174254. https://doi.org/10.1542/peds. 2017-4254 DOI: https://doi.org/10.1542/peds.2017-4254
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616 DOI: https://doi.org/10.1080/1364557032000119616
Begun S. The paradox of homeless youth pregnancy: a review of challenges and opportunities. Soc Work Health Care. 2015;54(5):444-60. https://doi.org/10.1080/00981389.2015.1030058 DOI: https://doi.org/10.1080/00981389.2015.1030058
Winetrobe H, Rhoades H, Barman-Adhikari A, Cederbaum J, Rice E, Milburn N. Pregnancy attitudes, contraceptive service utilization, and other factors associated with Los Angeles homeless youths’ use of effective contraception and withdrawal. J Pediatr Adolesc Gynecol. 2013;26(6):314-22. https://doi.org/10.1016/j.jpag.2013.06.007 DOI: https://doi.org/10.1016/j.jpag.2013.06.007
Kozlowski Z, Sanders JN, Panushka K, Myers K, Millar MM, Gawron LM. “It’s a vicious cycle”: a mixed methods study of the role of family planning in housing insecurity for women. J Health Care Poor Underserved. 2022;33(1):104-19. https://doi. org/10.1353/hpu.2022.0009 DOI: https://doi.org/10.1353/hpu.2022.0009
Goodman DJ, Wolff KB. Screening for substance abuse in women’s health: a public health imperative. J Midwifery Womens Health. 2013;58(3):278-87. https://doi.org/10.1111/jmwh.12035 DOI: https://doi.org/10.1111/jmwh.12035
Kittirattanapaiboon P, Srikosai S, Wittayanookulluk A. Methamphetamine use and dependence in vulnerable female populations. Curr Opin Psychiatry. 2017;30(4):247-52. https://doi.org/10.1097/YCO.0000000000000335 DOI: https://doi.org/10.1097/YCO.0000000000000335
Stewart J, Stadeli KM, Green ML, Etter-Carlson L, Dahl E, Davidson GH, et al. A co-located continuity clinic model to address healthcare needs of women living unhoused with opioid use disorder, who engage in transactional sex in North Seattle. Sex Transm Dis. 2020;47(1):e5-e7. https://doi.org/10.1097/OLQ.0000000000001064 DOI: https://doi.org/10.1097/OLQ.0000000000001064
Wagman JA, Park E, Giarratano GP, Buekens PM, Harville EW. Understanding perinatal patient’s health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana. BMC Pregnancy Childbirth. 2022;22(1):555. https://doi.org/10.1186/s12884-022-04883-w DOI: https://doi.org/10.1186/s12884-022-04883-w
Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, et al. A nurse case management HIV prevention intervention (come as you are) for youth experiencing homelessness: protocol for a randomized wait-listcontrolled trial. JMIR Res Protoc. 2021;10(5):e26716. https://doi.org/10.2196/26716 DOI: https://doi.org/10.2196/26716
Goodsmith N, Ijadi-Maghsoodi R, Melendez RM, Dossett EC. Addressing the urgent housing needs of vulnerable women in the era of COVID-19: the Los Angeles County Experience. Psychiatr Serv. 2021;72(3):349-52. https://doi.org/10.1176/appi. ps.202000318 DOI: https://doi.org/10.1176/appi.ps.202000318
Gordon AC, Lehane D, Burr J, Mitchell C. Influence of past trauma and health interactions on homeless women’s views of perinatal care: a qualitative study. Br J Gen Pract. 2019;69(688):e760-e767. https://doi.org/10.3399/bjgp19X705557 DOI: https://doi.org/10.3399/bjgp19X705557
DiTosto JD, Holder K, Soyemi E, Beestrum M, Yee LM. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021;3(6):100477. https://doi.org/10.1016/j.ajogmf.2021.100477 DOI: https://doi.org/10.1016/j.ajogmf.2021.100477
Kandasamy T, Cherniak R, Shah R, Yudin MH, Spitzer R. Obstetric risks and outcomes of refugee women at a single centre in Toronto. J Obstet Gynaecol Can. 2014;36(4):296-302. https://doi.org/10.1016/S1701-2163(15)30604-6 DOI: https://doi.org/10.1016/S1701-2163(15)30604-6
Esen UI. The homeless pregnant woman. J Matern Fetal Neonatal Med. 2017;30(17):2115-8. https://doi.org/10.1080/14767 058.2016.1238896 DOI: https://doi.org/10.1080/14767058.2016.1238896
Cutts DB, Coleman S, Black MM, Chilton MM, Cook JT, Cuba SE, et al. Homelessness during pregnancy: a unique, time- dependent risk factor of birth outcomes. Matern Child Health J. 2015;19(6):1276-83. https://doi.org/10.1007/s10995-014- 1633-6 DOI: https://doi.org/10.1007/s10995-014-1633-6
Leifheit K, Schwartz G, Pollack C, Edin K, Black M, Jennings J, et al. Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes. Int J Environ Res Public Health. 2020;17(22):8659. https://doi.org/10.3390/ ijerph17228659 DOI: https://doi.org/10.3390/ijerph17228659
St Martin BS, Spiegel AM, Sie L, Leonard SA, Seidman D, Girsen AI, et al. Homelessness in pregnancy: perinatal outcomes. J Perinatol. 2021;41(12):2742-8. https://doi.org/10.1038/s41372-021-01187-3 DOI: https://doi.org/10.1038/s41372-021-01187-3
Yamamoto A, Gelberg L, Needleman J, Kominski G, Vangala S, Miyawaki A, 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. https://doi.org/10.1001/jamanetworkopen.2021.7491 DOI: https://doi.org/10.1001/jamanetworkopen.2021.7491
Batra K, Pharr J, Olawepo JO, Cruz P. Understanding the multidimensional trajectory of psychosocial maternal risk factors causing preterm birth: a systematic review. Asian J Psychiatr. 2020;54:102436. https://doi.org/10.1016/j.ajp.2020.102436 DOI: https://doi.org/10.1016/j.ajp.2020.102436
Huang K, Waken RJ, Luke AA, Carter EB, Lindley KJ, Joynt Maddox KE. Risk of delivery complications among pregnant people experiencing housing insecurity. Am J Obstet Gynecol MFM. 2023;5(2):100819. https://doi.org/10.1016/j.ajogmf.2022.100819 DOI: https://doi.org/10.1016/j.ajogmf.2022.100819
Borghi C, Caillet P, Devriendt S, Lebeaupin M, Poirier M, Poveda JD. The perceived impact of homelessness on health during pregnancy and the postpartum period: A qualitative study carried out in the metropolitan area of Nantes, France. PLoS One. 2023;18(2):e0280273. https://doi.org/10.1371/journal.pone.0280273 DOI: https://doi.org/10.1371/journal.pone.0280273
Orlando MS, Vable AM, Holt K, Wingo E, Newmann S, Shapiro BJ, et al. Homelessness, housing instability, and abortion outcomes at an urban abortion clinic in the United States. Am J Obstet Gynecol. 2020;223(6):892.e1-892.e12. https://doi. org/10.1016/j.ajog.2020.07.002 DOI: https://doi.org/10.1016/j.ajog.2020.07.002
O’Brien JRG, Brar P, Worley J, Woodlee CH, Kelly ED, So M, et al. Development of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness. Prog Community Health Partnersh. 2022;16(4):473- 89. https://doi.org/10.1353/cpr.2022.0070 DOI: https://doi.org/10.1353/cpr.2022.0070
Ginn C, Mughal MK, Pruett MK, Pruett K, Perry RL, Benzies K. Engaging from both sides: facilitating a canadian two- generation prenatal-to-three program for families experiencing vulnerability. Can J Nurs Res. 2020;52(2):117-28. https://doi. org/10.1177/0844562120905710 DOI: https://doi.org/10.1177/0844562120905710
Kurata N, Minton L, Del Priore D, Merino D, Miller C, Lee MJ. An interim report on the provision of prenatal care for pregnant mothers experiencing homelessness in Hawai’i. Hawaii J Health Soc Welf. 2020;79(5 Suppl 1):118-21.
Rayment-Jones H, Dalrymple K, Harris J, Harden A, Parslow E, Georgi T, et al. Project20: does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study. PLoS One. 2021;16(5):e0250947. https://doi.org/10.1371/journal.pone.0250947 DOI: https://doi.org/10.1371/journal.pone.0250947
Natalino M. Estimativa da população em situação de rua no Brasil (2012–2022) [Internet]. Brasília: Ipea; 2022 [accessed on Feb 10, 2024]. Available at: https://repositorio.ipea.gov.br/bitstream/11058/11604/1/NT_Estimativa_da_Populacao_ Publicacao_Preliminar.pdf DOI: https://doi.org/10.38116/ntdisoc103
Prefeitura da Cidade do Rio de Janeiro. Censo da população em situação de rua 2022. Rio de Janeiro: Instituto Pereira Passos; 2022 [accessed on Feb 10, 2024]. Available at: https://www.data.rio/documents/64fc9f1756b64f05827a54de8c89a5ed/about
Hallais JAS, Barros NF. Consultório na rua: visibilidades, invisibilidades e hipervisibilidade. Cad Saúde Pública. 2015;31(7):1497-504. https://doi.org/10.1590/0102-311X00143114 DOI: https://doi.org/10.1590/0102-311X00143114
Paula HC, Daher DV, Koopmans FF, Faria MGA, Brandão PS, Scoralick GBF. Implementation of the Street Outreach Office in the perspective of health care. Rev Bras Enferm. 2018;71(suppl 6):3010-5. https://doi.org/10.1590/0034-7167-2017-0616 DOI: https://doi.org/10.1590/0034-7167-2017-0616
Clark RE, Weinreb L, Flahive JM, Seifert RW. Homelessness contributes to pregnancy complications. Health Aff (Millwood). 2019;38(1):139-46. https://doi.org/10.1377/hlthaff.2018.05156 DOI: https://doi.org/10.1377/hlthaff.2018.05156
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Derechos de autor 2025 Danielle Magno Azevedo da Silva, Fernanda Aparecida Santos, Gabriela Mello Cerqueira Ribeiro, Gabriela Pacheco Garcia, Gustavo Haddad Cypriano, Roberta Coura Calazans de Cerqueira, Mariana Mendes Bastos Figueiredo
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