Food insecurity during pregnancy in high-income countries, and maternal weight and diet: a systematic review and meta-analysis

Food insecurity is a well-established obesity driver. Less is known about food insecurity in pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG) and nutrition. Searches included seven databases, grey literature, references, citations, and contacting authors. Observational studies reporting data from January 1st 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD) and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n=19 North America, n=1 Europe; n=32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.