Introduction and Objective: Food insecurity (FI), a lack of consistent access to nutritionally adequate and safe food, affects more than 10% of Americans. FI is associated with adverse health outcomes including obesity and diabetes, but there is limited data about the impact of FI in pregnancy. Our objective was to determine the association between maternal FI and pregnancy outcomes.Methods: This retrospective cohort study evaluated deliveries in a single health system from 1/1/2018-6/30/2023 and included all patients who were screened for FI during pregnancy using the 2-question Hunger Vital Sign. Demographics, clinical characteristics, and pregnancy outcomes were extracted from the EMR and were compared between those with and without FI in univariable analysis. Stepwise multivariable logistic regression was performed to determine the association between FI and pregnancy outcomes.Results: Of 21,640 pregnant patients screened for FI, 1,543 (7%) were food insecure. The majority (91%) of those with FI also screened positive for other social determinants of health (SDoH). Those with FI were more likely to have obesity (42 vs 31%), pregestational diabetes (3 vs 1%), and chronic hypertension (6 vs 4%) compared to patients without. On adjusted analysis, pregnant people with FI had a higher odds of GDM (aOR 1.25, 95% CI 1.01-1.54, p=0.04), preterm birth <37 weeks (aOR 1.39, 95% CI 1.19-1.63, <0.01), and preterm birth <34 weeks (aOR 1.37, 95% CI 1.05-1.78, p=0.02) [model accounting for pregravid obesity as well as gestational/pregestational diabetes and gestational age at delivery when appropriate]. FI was not associated with increased odds of severe maternal morbidity, cesarean delivery, NICU admission, or macrosomia.Conclusion: Food insecurity during pregnancy is associated with preexisting diet-related chronic diseases, as well as GDM and preterm birth. FI is an important SDoH that may contribute to adverse pregnancy outcomes. All pregnant people should be screened for FI.
C. Dolin: None. A. Kern-Goldberger: None. M. Hopkins: None. S. Ehrenberg Buchner: Advisory Panel; Dexcom, Inc.
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