2025 Scholars' Research Symposium Abstract: Food Security During Pregnancy and Adverse Birth Outcomes.

Introduction: In the United States, offspring outcomes of preterm birth and low birth weight contribute to numerous infant health complications and healthcare costs. Food insecurity during the prenatal period may negatively impact maternal and child health, though limited research exists investigating this unique independent relationship. Especially amidst the COVID-19 pandemic, which elevated rates of food insecurity, it is necessary to understand food insecurity as a unique stressor with a potential relationship to adverse pregnancy outcomes. Using a large diverse prospective cohort of pregnant people in South Dakota, this study investigated the independent relationship between FI and infant outcomes, early gestational age and low birth weight.

Methods: Data from 1,478 pregnant people were obtained from the Environmental Influences on Child Health Outcomes in the Northern Plains PASS-ECHO study in South Dakota from 2020-2023. Maternal and infant outcomes were obtained through a hierarchy of medical record abstraction and self-reported data. Self-reported food insecurity was measured using a modified United States Department of Agriculture food security questionnaire. Descriptive statistics and logistic regression were conducted using SAS software to identify significant relationships between food insecurity and adverse offspring outcomes.

Results: In the sample, 20.7% (n=306) of pregnant people experienced food insecurity. Unadjusted data in the univariate model showed a statistically significant relationship between earlier gestational age and maternal food insecurity, with food insecure infants born on average around 3 days before food secure infants (p=0.0009), which made the average food insecure infant preterm, less than 37 weeks gestational age. Similarly, there was a statistically significant relationship between low infant birth weight and maternal food insecurity, with food insecure infants weighing 3.3% less than their food-secure counterparts on average (p=0.0203). However, in the multiple linear regression, adjusted for covariates accounting for socioeconomic status, these associations did not remain significant. Elevated pre-pregnancy BMI continued to have a statistically significant association with low birth weight and preterm birth even after adjusting for covariates.

Conclusion: Study findings showed there was no statistically significant association between food insecurity and low birth weight or earlier gestational age in adjusted models despite a statistically significant association existing in unadjusted models. However, elevated pre-pregnancy BMI was independently associated with low birth weight and earlier gestational age and should be investigated further regarding maternal food insecurity during pregnancy. Understanding food insecurity as a social determinant of health has critical consequences for both maternal and child health. Future research should investigate interventions to decrease food insecurity during pregnancy.