Maternal food insecurity tied to adverse pregnancy outcomes

Pregnant women with food insecurity are at greater risk of developing some adverse pregnancy outcomes, such as mental health problems and gestational diabetes mellitus (GDM), suggests a study.

Food insecurity refers to “the limited or uncertain availability of nutritionally adequate or safe foods and limited or uncertain ability to acquire foods in socially acceptable ways.” [J Nutr 1990;120:1555-1660]

“However, little data were available outside of the North America context, and thus a key recommendation from this review is for further research in wider high-income countries (HIC) contexts to fully explore potential associations, especially in countries with high prevalence of food insecurity,” the investigators said.

This systematic review and meta-analysis utilized eight databases (ie, Medline, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and Cinahl) and included grey literature, citation chaining, and contacting authors. Studies in HIC with data on food insecurity in pregnancy and maternal or infant health from 1 January 2008 to 21 November 2023 were included.

The investigators conducted a random-effects meta-analysis when data were suitable for pooling. If not, they performed a narrative synthesis. A total of 24,223 studies were identified, of which 25 (n=93,871 women; 23 from North America and two from Europe) met the eligibility criteria.

Based on the meta-analysis, maternal food insecurity significantly correlated with high stress levels (odds ratio [OR], 4.07, 95 percent confidence interval [CI], 1.22–13.55; I², 96.40 percent), mood disorder (OR, 2.53, 95 percent CI, 1.46–4.39; I², 55.62 percent), and GDM (OR, 1.64, 95 percent CI, 1.37–1.95; I², 0.00 percent). [PLoS Med 2024;21:e1004450]

On the other hand, food insecurity was not associated with caesarean delivery (OR, 1.42, 95 percent CI, 0.78–2.60; I², 56.35 percent), birth weight (mean difference, –58.26 g, 95 percent CI, –128.02 to 11.50; I², 38.41 percent), small-for-gestational age (OR, 1.20, 95 percent CI, 0.88–1.63; I², 44.66 percent), and large-for-gestational age (OR, 0.88, 95 percent CI, 0.70–1.12; I², 11.93 percent).

Similarly, food insecurity in pregnancy showed no significant relationship with either preterm delivery (OR, 1.18, 95 percent CI, 0.98–1.42; I², 0.00 percent) or neonatal intensive care (OR, 2.01, 95 percent CI, 0.85–4.78; I², 70.48 percent).

Mental health

In narrative synthesis, food insecurity significantly correlated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. No significant associations were seen with organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity.

Furthermore, there were mixed associations observed for pre-eclampsia, hypertension, and community or resilience measures.

“The associations between food insecurity and maternal mental health outcomes could be a consequence of the compounded effect from intersecting and interconnected inequalities such as gender and class,” the investigators said. 

Earlier studies have shown that due to lack of income, many women are unable to take the normal consumer pathways for purchasing food, experiencing feelings of tension between their nutritional desires and their inability to meet them, as well as uncertainties around food access. [Soc Sci Med 2022;311:115313]

“Findings of this review are important to inform the improvements in maternity services to better be able to support women experiencing food insecurity, particularly relating to a need for screening for food insecurity in conjunction with GDM and mental health,” the investigators said. 

“Importantly, these results identify potential life course implications of experiencing food insecurity in pregnancy for both women’s health and their children’s health, alongside increasing prevalence of food insecurity in many HICs,” they added.