Food security, diet behavior, home food environment, and pregnancy outcomes among pregnant WIC participants

Literature suggests that low-income pregnant women are at significant risk of experiencing socio-economic disparities that jeopardize their health and nutritional status. Women from economically disadvantaged backgrounds are more likely to be overweight or obese before and during pregnancy. These women are also more likely to experience food insecurity and limited resources that can lead to poor diet quality and excessive gestational weight gain (GWG) and subsequent pregnancy complications. Life course theory and the fetal origins of disease hypothesis cite that these factors can then influence the health trajectory of newborns by increasing the risk of fetal adiposity (large for gestational age) and subsequent metabolic dysfunction later in life. The overall objectives of this study were to (a) examine the relationship between home food environment (fruit and vegetable (F&V) availability), diet behavior (frequency of F&V intake), and food security status of pregnant WIC participants; (b) examine the association between food security status and pregnancy outcomes (GWG); and (c) examine the association between food security status and birth outcomes (birth weight and gestational age or size for gestational age). A cross-sectional community based design was used to interview pregnant women during a WIC maternity certification appointment. WIC clients were included if they were = 18 years old, 13–27 weeks pregnant, and able to speak English or Spanish. Food insecurity was found among 43% of participants. Food insecurity was not significantly associated with any sociodemographic variables in this sample, or directly associated with GWG or birth outcomes. However, home food environment (availability of F&V) indirectly mediated the relationship between food security status and daily F&V intake in a positive manner (p < 0.05). Excess GWG was significantly associated with being single, primiparous, an overweight/obese pre-pregnancy BMI, unplanned pregnancy, and having a non-normal size for gestational age infant. Regression analyses further indicated that identifying as African American, having an unplanned pregnancy, and being obese put them at significant odds of gaining excess weight. The findings suggest that while food insecurity had no direct associations or affects, it may be indirectly impacting fruit and vegetable intake by altering availability of these items. Addressing family planning and pre-conception weight status may be key in reducing excess GWG and the risk of having a non-normal size for gestational age infant