Kaiser Permanente researchers also found no increased risk in those who received food assistance during pregnancy
People who experienced food insecurity during pregnancy were more likely to have complications with the pregnancy, according to new Kaiser Permanente research. The increased risk did not appear among those who received food assistance.
“These findings are significant, as very few studies have specifically examined food insecurity and health outcomes during pregnancy,” said lead author Rana Chehab, PhD, MPH, RD, a staff scientist at the Kaiser Permanente Division of Research (DOR). “Our study highlights the importance of discussing food access with pregnant individuals and connecting those with food insecurity to support programs.”
The study was published in JAMA Network Open and analyzed surveys completed by pregnant patients of Kaiser Permanente Northern California (KPNC) between June 2020 and September 2022, asking about their experiences with pregnancy during the early COVID-19 pandemic period. There were 19,338 individuals included in the study, and 14% reported food insecurity.
Those respondents said “yes” to at least one of 2 questions: if they were worried that their food would run out before they got money to buy more, or if the food they bought did not last and they did not have money to buy more.
Those reporting food insecurity had increased risk of gestational diabetes, preeclampsia, preterm birth, and NICU admission for the baby.
Of all respondents, 7.6% said they received food assistance during their pregnancy. Among these, there was no increased risk of complications.
Chehab described the finding as compelling, paving the way for future research on the role of food assistance programs in addressing the relationship between food insecurity and pregnancy complications.
“It is reassuring to observe that among individuals who received food assistance, food insecurity was not linked to an increased risk of any of the pregnancy complications we studied,” Chehab said. “However, given the observational nature of our research, we cannot definitively conclude that programs like WIC [the Women, Infants & Children Supplemental Nutrition Program] specifically provided protection against food insecurity during pregnancy. This will need to be validated in future interventional studies.”
Potential mechanisms for that connection could include the stress associated with worrying about where the next meal is coming from for both the patient and their family, as well as the physical effects of an inadequate diet, Chehab said.
“Our study underscores the critical need to address food insecurity during pregnancy as a fundamental component of prenatal care,” said co-senior author Yeyi Zhu, PhD, a DOR research scientist. “Future research should explore how integrating nutrition support into prenatal care can further enhance maternal and neonatal health outcomes.”
The KPNC pandemic pregnancy survey asked pregnant individuals a wide array of questions about their health and lifestyle during the early pandemic years. Chehab said the survey’s 2 questions about food insecurity offered a unique view into the issue that other health screenings don’t routinely explore. “Food insecurity during pregnancy is not well studied, but it is a public health concern,” Chehab said.
The findings add weight to existing recommendations from the American College of Obstetrics and Gynecology to ask pregnant people about social factors in their lives, including access to food.
“Data for this study were collected via a survey aimed at understanding the effect of COVID-19 pandemic on pregnancy health,” said co-senior author Assiamira Ferarra, MD, PhD, senior research scientist at DOR. “It was reassuring to see that even during difficult times, receiving food assistance may mitigate the adverse effect of food insecurity on pregnancy complications.”
The study was funded by the DOR Health Equity and Diversity Scholars Program, Kaiser Permanente Northern California Community Health, and the National Institutes of Health.
Additional co-authors were Amanda L. Ngo, MPH, of the Division of Research; Mara B. Greenberg, MD, of The Permanente Medical Group; and Barbara A. Laraia, PhD, of the University of California, Berkeley.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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