June 2010

Household Food Insecurity Is Associated with Self-Reported Pregravid Weight Status, Gestational Weight Gain, and Pregnancy Complications.

BARBARA A. LARAIA, PhD, MPH, RD; ANNA MARIA SIEGA-RIZ, PhD, RD; CRAIG GUNDERSEN, PhD

The purpose of this original research was to identify whether an independent association exists between household food insecurity and pregnancy-related complications. The participants in the study included 810 women who had participated in the Pregnancy, Infection, and Nutrition Cohort Study. This study retrospectively assessed household food insecurity using the USDA 18-Item Core Food Security Module; inclusion criteria for participants required incomes less than or equal to 400% of the income/poverty ratio.

For the purpose of this study, food insecurity has been defined as, "whenever the availability of nutritionally adequate and safe food, or the ability to acquire acceptable foods in socially acceptable ways, is limited or uncertain."

Household food insecurity is associated with: significant decrease in fruit and vegetable intake, decreased micronutrient intake in women, significant increase in disordered eating, overweight and obesity in women (especially among ethnic minorities and women in rural settings). Household food insecurity is also associated with compromised psychosocial function, poor mental health, and depression. In addition, overweight pregravid status is associated with: poor dietary intake, excessive weight gain, gestational diabetes mellitus, pre-eclampsia, pregnancy-induced hypertension, and postpartum anemia. Researcher propose that because pregnancy is a time when a woman faces remarkable physical, psychological and emotional changes and stress, the negative health consequences of food insecurity will have a direct and negative impact on maternal and fetal health.

The researchers highlight the paradoxical relationship between food insecurity and weight status. That is, women in food insecure households report a higher prevalence of overweight and obesity, and related health comorbidities. This study reveals that food insecure women are three times more likely to be severely obese than their food secure counterparts.

Results from this study conclude that household food insecurity is significantly and independently associated with severe pregravid obesity, excessive weight gain during pregnancy, and development of gestational diabetes mellitus. More specifically, women from marginally food insecure homes were associated with second trimester anemia and gestational diabetes. Women from food insecure households were associated with pregnancy-induced hypertension. After adjusting for age, race, maternal education, marital status, children, income/poverty ratio, pregravid BMI, physical activity, and smoking status; women from food insecure and marginally food insecure households had a greater than twofold increase in gestational diabetes (p<.05). Thus, living in a household with any level of food insecurity increases one's likelihood of experiencing excessive weight gain and complications (GDM) during pregnancy.

Laraia, B. A., Siega-Riz, A. M., Gundersen, C. (2010). Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. Journal of the American Dietetic Association, 110(5), 692-701.