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

Author

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

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. In a systematic review and a random effect meta-analysis, Zoe Bell and colleagues investigate associations between food insecurity during pregnancy and maternal and infant health in high-income countries.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Zoë Bell & Giang Nguyen & Gemma Andreae & Stephanie Scott & Letitia Sermin-Reed & Amelia A Lake & Nicola Heslehurst, 2024. "Associations between food insecurity in high-income countries and pregnancy outcomes: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 21(9), pages 1-26, September.
    • Handle: RePEc:plo:pmed00:1004450
    DOI: 10.1371/journal.pmed.1004450
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    References listed on IDEAS

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    1. Bell, Zoë & Scott, Steph & Visram, Shelina & Rankin, Judith & Bambra, Clare & Heslehurst, Nicola, 2022. "Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography," Social Science & Medicine, Elsevier, vol. 311(C).
    2. Hamilton, William L. & Cook, John T. & Thompson, William W. & Buron, Lawrence F. & Frongillo, Edward A., Jr. & Olson, Christine M. & Wehler, Cheryl A., 1997. "Household Food Security in the United States in 1995: Technical Report of the Food Security Measurement Project," USDA Miscellaneous 344955, United States Department of Agriculture.
    3. Cantillon, Bea & Chzhen, Yekaterina & Handa, Sudhanshu & Nolan, Brian (ed.), 2017. "Children of Austerity: Impact of the Great Recession on Child Poverty in Rich Countries," OUP Catalogue, Oxford University Press, number 9780198797968, Decembrie.
    4. Nicola Heslehurst & Rute Vieira & Zainab Akhter & Hayley Bailey & Emma Slack & Lem Ngongalah & Augustina Pemu & Judith Rankin, 2019. "The association between maternal body mass index and child obesity: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 16(6), pages 1-20, June.
    5. Abimbola A Ayorinde & Iestyn Williams & Russell Mannion & Fujian Song & Magdalena Skrybant & Richard J Lilford & Yen-Fu Chen, 2020. "Assessment of publication bias and outcome reporting bias in systematic reviews of health services and delivery research: A meta-epidemiological study," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-17, January.
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    1. Oresnik, Sarah & Moffat, Tina & McKerracher, Luseadra & Sloboda, Deborah M., 2025. "A syndemic perspective on food insecurity, gestational diabetes, and mental health disorders during pregnancy," Social Science & Medicine, Elsevier, vol. 373(C).

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