Pregnancy & COVID-19: How the Number of People Per Household is Related to Infection Rates

A study of nearly 400 pregnant women is among the first to show that household crowding and neighborhood socioeconomic status are risk factors of contracting COVID-19.

Exterior of apartment building with lots of windows and fire escapes.

A study of nearly 400 pregnant women in New York City is among the first to show that those who live in neighborhoods with more household crowding are at higher risk of becoming infected with the coronavirus that causes COVID-19. Pregnant women who live in neighborhoods with lower socioeconomic status are also at increased risk of infection.

Dr. Cynthia Gyamfi-Bannerman

Dr. Cynthia Gyamfi-Bannerman

“One may think that because New York City is so dense, there’s little that can slow the spread of the virus, but our study suggests the risk of infection is related to household, rather than urban density,” says co-author Dr. Cynthia Gyamfi-Bannerman, the Ellen Jacobson Levine and Eugene Jacobson Professor of Women’s Health in Columbia’s Department of Obstetrics and Gynecology and a maternal-fetal medicine specialist at NewYork-Presbyterian/Columbia University Irving Medical Center.

The researchers examined the relationships between SARS-CoV-2 infection and neighborhood and building characteristics in 396 women who gave birth at NewYork-Presbyterian/Columbia University Irving Medical Center or NewYork-Presbyterian Allen Hospital during the peak of the COVID-19 outbreak in New York City.

Since March 22, all women admitted to the hospitals for delivery have been tested for the virus, which gave the researchers the opportunity to detect all infections — including infections with no symptoms — in a defined population.

Household Density Strongest COVID-19 Predictor

The strongest predictor of COVID-19 infection among these women was residence in a neighborhood where households with many people are common. Pregnant women who lived in a neighborhood with high “household membership,” meaning a lot of people per household, were three times more likely to be infected with the virus, and greater household crowding (defined as a family with more than one person per room) in the neighborhood was also a factor.

There was, however, no association between infection and overall population density.

“New York City has the highest population density of any city in the United States, but our study found that the risks are related more to density in people’s domestic environments rather than density in the city or within neighborhoods,” says Gyamfi-Bannerman.

“For our pregnant patients, that may mean counseling women about the risk of infection if they are considering bringing in other family members to help during pregnancy or postpartum,” she says. This also signals the need to provide more guidance and information about safety measures for pregnant women who live in multi-generational homes.

Dr. Alexander Melamed

Dr. Alexander Melamed

Public Health Implications

The study, published online June 18 in JAMA, the Journal of the American Medical Association, also reveals important information for public health officials.

“Our study shows that neighborhood socioeconomic status and household crowding are strongly associated with risk of infection,” says the study’s leader, Dr. Alexander Melamed, an assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons and a gynecologic oncologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

For example, the study shows that women were twice as likely to get COVID-19 if they lived in neighborhoods with high unemployment rates. These data may aid public policy makers when creating intervention plans to reduce the spread moving forward.

“The knowledge that SARS-CoV-2 infection rates are higher in lower income neighborhoods and among people who live in crowded households,” Dr. Melamed says, “could help public health officials target preventive measures, like distributing masks or culturally competent educational information to these populations when necessary.”

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