Energy efficiency of housing and its association with pregnancy outcomes

Children born in low socioeconomic circumstances (SES) are at increased risk of adverse health outcomes throughout life. They also more often grow up in lower quality homes, which poses additional risks for their health. Although there is no robust measurement of housing quality available, energy efficiency could approximate this. In this study, we aim to investigate the associations between energy efficiency and being born preterm (PTB) or small for gestational age (SGA). Data from the national perinatal registry (2015-2021, Perined) on all singleton births were linked to registry data covering place of residence, type of household and housing characteristics (WoonBase, Statistics Netherlands). PTB was defined as birth below 37 weeks of gestation, and SGA as birth weight below the 10th centile corrected for gestational age and sex. Energy use per m2 was calculated by dividing the yearly energy use (gas and electricity) by the floor surface of the house in m2. High energy use was defined as energy use above the 75th centile, based on visual inspection of the continuous association. Logistic regression models estimated the associations between high energy use and PTB or SGA, corrected for parity, mothers’ age, single parenthood, type of housing, ownership, and neighbourhood SES. Data on birth outcomes, energy/m2 and covariates were available in 759,243 cases. The prevalence of PTB was 5.3% and 9.4% for SGA. High energy/m2 was significantly associated with PTB and SGA, with aOR 1.13 (95%CI 1.10 – 1.58) and aOR 1.13 (95%CI 1.11 – 1.54), respectively. Covariates living in a multi-family dwelling, social housing and single parent household were also significantly associated with higher odds for both outcomes. Newborns from homes with high energy use have a higher odds of being born PTB or SGA. Increasing energy efficiency can improve housing quality, with potental health benefits. Future research should assess its potential to benefit perinatal and child health.

Key messages

• Energy use per m2 is significantly associated with a higher odds for adverse birth outcomes.

• Improving energy efficiency of homes has the potential to improve health of current and future generations.