Food insecurity is a significant public health concern in the U.S. and contributes to adverse health outcomes with increased healthcare costs. While national estimates for food insecurity among pregnant women in the U.S. are not available. However, limited data on peripartum individuals shows a concerning prevalence of 10.8% from 2019 to 2021. Studies have found that perinatal complications such as gestational diabetes (GD), risk of preterm birth, and low birth weight, are common among individuals experiencing food insecurity during pregnancy.
Food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for women, infants, and Children (WIC), are designed to improve nutrition and health outcomes. Studies on non-pregnant individuals have shown mixed results about their impact on the correlation between food insecurity and health outcomes. This gap underscores the importance of investigating between food insecurity, food assistance, and perinatal health outcomes.
The cohort study published in JAMA Network Open investigated the association between food insecurity during pregnancy and the risk of maternal and neonatal complications. The study also explored whether these associations differed based on the receipt of food assistance during pregnancy.
This study utilized data from an online survey conducted from June 22, 2022, to September 9, 2022, within the Kaiser Permanente Northern California (KPNC) healthcare system. This system provides electronic health records (EHR) of 4.6 million members across 21 hospitals and ≥255 outpatient clinics in Northern California. Food insecurity was determined using the validated 2-item. Hunger Vital Sign screener, where maternal and neonatal complications were extracted from the EHR.
A total of 19,338 individuals (Age at delivery = 18-54 years, Hispanic = 3847, White = 9383) were included in this study. Among participants, 14% (n = 2707) of pregnant individuals reported food insecurity. It was found that pregnant participants experiencing food insecurity had a higher prevalence of perinatal complications, such as GD (10.9% vs 7.9%), preeclampsia (8.1% vs 6.3%), preterm birth (8% vs 6.1%), neonatal intensive care unit (NICU) admission (9.8% vs 7.5%), composite adverse perinatal outcome (APO, 41.1% vs 36.8%) compared to those without food insecurity (P < 0.001).
In contrast, no significant differences were observed between food-insecure and food-secure pregnant individuals in the prevalence of gestational hypertension (10.6% vs. 11.7%; P = 0.12), cesarean delivery (27.5% vs. 25.8%; P = 0.10), small-for-gestational-age (SGA; 12.1% vs. 11.5%; P = 0.29), or large-for-gestational-age (LGA; 10.8% vs. 10.0%; P = 0.22).
Of the study participants, 7.6% (n = 1471) received food assistance during the pregnancy from WIC (4.3%), SNAP (3.3%), and the coronavirus food assistance program (CFAP, 0.1%). Among 7.6% of households, the associations between food insecurity and perinatal complications were reduced to null, except for preeclampsia (aRR = 1.64, 95% CI, 1.06-2.53).
Moreover, among households who did not receive food assistance during pregnancy, those with food insecurity had a higher risk of GD (adjusted relative risk [aRR] = 1.13, 95% confidence interval [CI], 1.10-1.29), preeclampsia (aRR = 1.28, 95% CI, 1.11-1.49), preterm birth (aRR = 1.19, 95% CI, 1.02-1.38), NICU admission (aRR = 1.23, 95% CI, 1.07-1.42), APO (aRR = 1.07, 95% CI, 1.02-1.13), cesarean delivery (aRR = 1.09, 95% CI, 1.01-1.18), but no increased risk for gestational hypertension (aRR = 0.94, 95% CI, 0.82-1.08), SGA (aRR = 1.08, 95% CI, 0.95-1.22), and LGA (aRR = 1.00, 95% CI, 0.87-1.15).
This study’s limitations include its focus on populations in Northern California. Some unmeasured factors, such as housing conditions and income, may still influence the results.
In conclusion, this study highlighted the association between food insecurity during pregnancy and an increased risk of perinatal complications (maternal and neonatal), with attenuated associations observed in participants who received food assistance during pregnancy.
Reference: Chehab RF, Croen LA, Laraia BA, et al. Food Insecurity in Pregnancy, Receipt of Food Assistance, and Perinatal Complications. JAMA Netw Open. 2025;8(1):e2455955. doi:10.1001/jamanetworkopen.2024.55955
