Associations between food insecurity in high-income countries and pregnancy outcomes: A systematic review and meta-analysis

IF 10.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

PLoS Medicine Pub Date : 2024-09-10 DOI:10.1371/journal.pmed.1004450

Zoë Bell, Giang Nguyen, Gemma Andreae, Stephanie Scott, Letitia Sermin-Reed, Amelia A. Lake, Nicola Heslehurst

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Abstract

Background Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes. Methods and findings Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD −58.26 g, 95% CI [−128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures. Conclusions Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

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高收入国家粮食不安全与妊娠结局之间的关系：系统回顾和荟萃分析

背景孕产妇营养对孕期和几代人的健康至关重要。孕期食物不安全是导致孕产妇饮食不平等的一个因素，并可能对母婴健康造成影响。本系统综述探讨了孕期食物不安全与母婴健康结果之间的关联。方法和结果搜索范围包括 8 个数据库（MEDLINE、Embase、Scopus、Web of Science、PsychInfo、ASSIA、ProQuest 中的 SSPC 和 CINAHL）、灰色文献、正向和反向引文链以及联系作者。本研究纳入了高收入国家（HICs）在 2008 年 1 月 1 日至 2023 年 11 月 21 日期间报告妊娠期粮食不安全和母婴健康数据的研究。筛选、数据提取和质量评估均独立进行，一式两份。如果数据适合汇总，则进行随机效应荟萃分析，否则进行叙述性综合分析。研究方案已在 PROSPERO（CRD42022311669）上注册，并按照 PRISMA 检查表（S1 文件）进行了报告。搜索共发现 24,223 项结果，纳入了 25 项研究（n = 93,871 名女性）：其中 23 项来自北美，2 项来自欧洲。元分析表明，食物不安全与高压力水平（OR 4.07，95% CI [1.22，13.55]，I2 96.40%）、情绪障碍（OR 2.53，95% CI [1.46，4.39]，I2 55.62%）、妊娠糖尿病（OR 1.64，95% CI [1.37，1.95]，I2 0.00%），但不包括剖宫产（OR 1.42，95% CI [0.78，2.60]，I2 56.35%）、出生体重（MD -58.26 g，95% CI [-128.02, 11.50]，I2 38.41%）、小胎龄（OR 1.20，95% CI [0.88, 1.63]，I2 44.66%）、大胎龄（OR 0.88，95% CI [0.70，1.12] I2 11.93%）、早产（OR 1.18，95% CI [0.98，1.42]，I2 0.00%）或新生儿重症监护（OR 2.01，95% CI [0.85，4.78]，I2 70.48%）。叙述性综述显示，食物不安全与牙科问题、抑郁、焦虑和母体血清中全氟辛烷磺酸浓度有显著关联。与其他有机卤素化学品、助产、产后出血、入院、住院时间、先天性畸形或新生儿发病率无明显关联。先兆子痫、高血压和社区/复原力等方面存在混合关联。结论孕产妇粮食不安全与一些不良妊娠结局有关，尤其是精神健康和妊娠糖尿病。大多数纳入的研究都是在北美（主要是美国）进行的，这凸显了其他地区的研究差距。有必要在其他高收入国家/地区开展进一步研究，以了解在不同情况下（如那些没有实施嵌入式干预措施的国家/地区）的这些关联，从而为政策和护理要求提供依据。

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来源期刊

PLoS Medicine 医学-医学：内科

CiteScore

21.60

自引率

0.60%

发文量

227

审稿时长

3 months

期刊介绍： PLOS Medicine aims to be a leading platform for research and analysis on the global health challenges faced by humanity. The journal covers a wide range of topics, including biomedicine, the environment, society, and politics, that affect the well-being of individuals worldwide. It particularly highlights studies that contribute to clinical practice, health policy, or our understanding of disease mechanisms, with the ultimate goal of improving health outcomes in diverse settings. Unwavering in its commitment to ethical standards, PLOS Medicine ensures integrity in medical publishing. This includes actively managing and transparently disclosing any conflicts of interest during the reporting, peer review, and publication processes. The journal promotes transparency by providing visibility into the review and publication procedures. It also encourages data sharing and the reuse of published work. Author rights are upheld, allowing them to retain copyright. Furthermore, PLOS Medicine strongly supports Open Access publishing, making research articles freely available to all without restrictions, facilitating widespread dissemination of knowledge. The journal does not endorse drug or medical device advertising and refrains from exclusive sales of reprints to avoid conflicts of interest.

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