Food insecurity raises the risk for maternal, neonatal complications during pregnancy
Key takeaways:
- Food insecurity in pregnancy increased the risk for various complications like NICU admission, preterm birth and gestational diabetes.
- However, food stamp assistance attenuated most of these risks.
Food insecurity occurred frequently among pregnant individuals and increased the risk for multiple adverse health outcomes like gestational diabetes and preeclampsia, results of a cohort study published in JAMA Network Open suggested.
Most of these risks were reduced to insignificant levels among individuals who received food stamps, however.
Healio previously reported that an increasing number of American families are facing food insecurity.
Despite this, the U.S. Preventive Services Task Force ruled that there is not enough evidence to recommend food insecurity screening in primary care.
The findings “were expected, as they align with existing research showing that food insecurity is associated with adverse health outcomes,” Rana F. Chehab, PhDMPH, RN, a staff scientist at the Kaiser Permanente Division of Research, told Healio.
But “what makes this study unique is its focus on food insecurity during pregnancy — an understudied area,” she added.
In the analysis, Chehab and colleagues examined food insecurity prevalence and its links with maternal and neonatal outcomes — and the impact of food assistance programs on these outcomes — using data from a pregnancy survey conducted at Kaiser Permanente Northern California between June 22, 2020, and Sept. 9, 2022.
Of 19,338 individuals who completed the survey, 14% reported food insecurity. These people had a higher likelihood of being Black or Hispanic, younger at delivery and reside in the most deprived neighborhoods vs. individuals without food insecurity.
Pregnant individuals with food insecurity, vs. those were food secure, had a higher risk for:
- gestational diabetes (adjusted RR = 1.13; 95% CI, 1.01-1.29);
- preeclampsia (aRR = 1.28; 95% CI, 1.11-1.49);
- preterm birth (aRR = 1.19; 95% CI, 1.02-1.38);
- neonatal ICU (NICU) admission (aRR = 1.23; 95% CI, 1.07-1.42); and
- adverse perinatal outcomes (APOs), a composite outcome of maternal and neonatal complications (aRR = 1.07; 95% CI, 1.02-1.13).
Food assistance given to 7.6% of those surveyed during pregnancy attenuated all associations between food insecurity and perinatal complications, except for preeclampsia (aRR = 1.64; 95% CI, 1.06-2.53).
In contrast, links between food insecurity and gestational diabetes (aRR = 1.2; 95% CI, 1.04-1.37), preeclampsia (aRR = 1.24; 95% CI, 1.06-1.46), preterm birth (aRR = 1.23; 95% CI, 1.05-1.46), NICU admission (aRR = 1.31; 95% CI, 1.12-1.52) and APO (aRR = 1.12; 95% CI, 1.06-1.18) remained in those who did not receive food assistance.
Chehab and colleagues explained that the mechanisms behind the associations between food insecurity and perinatal complications “are complex and remain to be elucidated.”
“One potential mechanism includes constrained food options, which may result in less healthy diets and significantly varying eating patterns due to inconsistent budgets,” they wrote. “This may contribute to visceral adiposity, inadequate weight gain and insulin resistance, which are associated with higher risk of perinatal complications like gestational diabetes.”
Chehab told Healio that the findings suggest food assistance programs “may play a critical role in mitigating the risks associated with food insecurity during pregnancy, though more research is needed to understand why the association with preeclampsia persists.”
Analysis limitations included limited generalizability to certain populations and possible recall bias from 22.1% of people responding to the survey postpartum.
Chehab said that primary care providers “should consider routine screening for food insecurity in pregnancy, as recommended by the American College of Obstetricians and Gynecologists.”
“Identifying food-insecure patients early allows for timely referrals to food assistance programs such as Special Supplemental Nutrition Program for Women, Infants and Children, which may help improve maternal and neonatal outcomes,” she added.
Perspective
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Food insecurity and poor nutrition will negatively impact a patient diagnosed with chronic/gestational hypertension, preeclampsia, and/or gestational diabetes. The patient cannot maintain dietary compliance with assistance. Even when the patient has excellent and consistent prenatal care, the goal of a healthy pregnancy cannot be achieved if the patient cannot be compliant with medical recommendations. When a patient's living condition is dangerous due to violence, poverty and/or overall mental health, it can make the physician's plan for providing health care insurmountable. If a baby is born prematurely due to severe hypertensive disease or uncontrolled diabetes in the mother, the cost of caring for the neonate in the ICU can be financially devastating.
Food insecurity extends beyond antenatal/perinatal care. If the mother's nutrition is poor, it can affect her ability to provide nutritious breast milk for her baby. This can be significant if she delivers the baby prematurely. I completed my residency training in the underserved area of inner-city Detroit in the mid-to-late 1990s and completely agree with the findings in this study because I witnessed it frequently. Sadly, not much has changed. Food deserts in underserved areas (both rural and urban) are significant contributors to maternal health, morbidity and mortality.
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