Anemia and food insecurity: the nutritional struggles of pregnant women in Lebanon amid unprecedented crises.

Abstract

Background: Pregnant women require specific dietary intake to optimize fetal development and support mother's health. The ongoing crises in Lebanon: the economic crisis, the COVID-19 pandemic, and the Beirut port explosion, limited the population's overall ability to consume a well-balanced diet, preventing adequate consumption of fresh, whole food and possibly disrupting people's eating habits, notably for pregnant women. Given the vulnerability of pregnant women to malnutrition and diseases during those times, research on the nutrition status and intake of pregnant women is urgently needed to inform targeted policies and programs. This study explores nutritional status (malnutrition and anemia), food insecurity, and diet quality, and associated factors in Lebanese adult pregnant women residing in Lebanon.

Methods: A cross sectional study was conducted on a representative sample of 500 adult Lebanese pregnant women who were in different pregnancy trimesters, between March and October 2023. Collected data included sociodemographic and medical characteristics, anthropometrics, serum hemoglobin, food security status, and diet quality using validated tools.

Results: A total of 38.6% of the participants had anemia, with more than half (53.8%) reporting not taking iron supplements. Food insecurity prevalence was 14.6% based on the "Food Insecurity Experience Scale" and 22.6% based on the "Arab Family Food Security Scale". Although most women in the sample (79.2%) had a high minimum dietary diversity (MDD-W) score and an acceptable household dietary diversity, however; around 38% and 81.6% of them had low adherence to the Mediterranean Diet (MD) and the USDA dietary guidelines, respectively. Being in the second (aOR: 1.77) or third (aOR:1.88) pregnancy trimesters increased the likelihoods of anemia; while being employed (aOR: 0.46) and having a higher household income (aOR: 0.639) decreased the likelihood of maternal anemia. Living in a crowded household (aOR: 0.072) decreased the odds of high MDD-W, while being employed (aOR: 2.88), being food secure (aOR: 1.76) and living in the North and Akkar (aOR: 2.44) or South and Nabatieh (aOR: 2.06) increased the odds of high MDD-W. Being food secure (aOR: 1.87) increased the likelihood of fair to very good MD adherence, while having a higher household income (aOR: 0.57) decreased adherence to MD. A higher household income (aOR: 0.57) decreased the adherence to USDA dietary guidelines.

Conclusion: Anemia, compounded by low levels of iron supplementation and low adherence to healthy diets, warrant immediate public action given the detrimental effects they have on pregnancy outcomes. National comprehensive nutrition policies and interventions are thus needed to enhance adherence to healthy diets and the overall health of pregnant women. This also requires improving the food security situation of Lebanese pregnant women, as our findings showed that food security increases the odds of dietary diversity and adherence to the MD.