P2C136: Food Insecurity During Pregnancy and Adverse Neonatal Outcomes: A Prospective Cohort Study in an Urban Population

Background: Food insecurity is a key driver of reproductive, pregnancy, and pediatric health outcomes. There are limited prospective studies that evaluate known food insecurity during pregnancy and neonatal outcomes in urban populations.

Methods: The primary objectives were to measure the (1) frequency of food insecurity in a pregnant population (2) association of food Insecurity during pregnancy and adverse neonatal outcomes. We conducted a community health stressors survey, which included the validated 6-Item USDA Food Security module, in a population of pregnant patients (15 years+) at one urban academic reproductive clinic during one prenatal or postpartum visit. Patients screened positive for food insecurity if they scored greater than 1 on the module. Neonatal outcomes were abstracted from the pregnant patient’s electronic medical record at delivery. We calculated the frequency of maternal food insecurity and performed bivariate logistic regression to assess the association between food insecurity and adverse neonatal outcomes.

Results: The majority of the 118 patients enrolled identified as Black (83%), 18-35 years (84.7%), and had an annual income less than $40,000/yr (67%). Nearly half (46%) of the mothers experienced food insecurity during their pregnancy. Experiencing food insecurity during pregnancy was associated with experience of food insecurity outside of pregnancy but no other factors (OR=22.2, 95% CI [8.4, 58.4]). The rate of adverse outcomes in our population were 16.1% for pre-term birth and 15.2% for low birth weight, which are higher than the national average. Food insecurity during pregnancy was not associated with increased odds of the following: pre-term birth (OR=0.9, 95% CI [0.3, 2.3]), LBW (OR=0.7 [0.3, 2.1]), or intrauterine growth restriction (OR=0.8 [0.1, 4.8]). Food insecurity was not associated with having an increased odds of having any adverse neonatal outcome (OR=0.6 [0.2, 1.4]). Additionally, those who were food insecure tended to be less likely to breastfeed, though this was not statistically significant (OR= 0.6, 95% CI [0.3, 1.3]).

Conclusion: In our preliminary prospective study, we did not find that food insecurity during pregnancy was associated with adverse neonatal outcomes in an urban population. Given that rates of adverse neonatal outcomes is higher in our population than the national average, further research should explore how food insecurity in combination with other structural and social barriers may impact adverse neonatal outcomes. Notably, food insecurity was extremely prevalent, affecting nearly 1 in 2 patients, emphasizing the need for universal screening in prenatal clinics to promote healthy maternal and pediatric outcomes. Further research that helps to understand the complex relationship between food insecurity during pregnancy and neonatal outcomes can guide the development of joint interventions across pediatric and reproductive clinics.