Abstract
Food insecurity (FI) is significantly associated with obesity and
adverse health outcomes in the general population. This
systematic review and meta-analysis (PROSPERO:
CRD42022311669) explored associations between women experiencing FI in pregnancy, and maternal obesity, gestational weight
gain, and pregnancy health outcomes for both mothers and
infants.
Searches included seven databases (MEDLINE, Embase, Scopus,
Web of Science, PsychInfo, ASSIA, CINAHL) and grey literature,
reference lists, citations, and contacting authors and completed in
April 2023. We included studies in high-income countries (HICs)
reporting data on food insecurity in pregnancy from Jan 1, 2008,
onwards. Screening, data extraction, and quality assessment were
carried out by two authors independently. Random effects metaanalysis was performed when data were suitable for pooling,
otherwise narrative synthesis was conducted. Searches identified
10,515 results; 27 studies (n = 87,850 women) included: 26 from
North America, 1 from the UK. Meta-analysis showed women
experiencing FI had significantly reduced gestational weight gain
(GWG) (MD −0.37 kg 95%CI −0.58, −0.17), increased odds of
maternal obesity (OR 1.53 95%CI 1.39, 1.66), inadequate GWG (OR
1.16 95%CI 1.05, 1.28), high stress level (OR 4.07, 95%CI 1.22–13.55),
gestational diabetes (OR 1.63, 95%CI 1.36–1.95) and preterm delivery
(OR 1.21, 95%CI 1.00–1.47). There was no statistically significant
association with maternal underweight (OR 1.12 95%CI 0.89, 1.34) or
overweight (OR 1.18 95%CI 0.86, 1.50), excessive GWG (OR 1.04 95%
CI 0.96, 1.13), small for gestational age (OR 1.14, 95%CI 0.72–1.80),
large for gestational age (OR 0.90, 95%CI 0.66–1.22) or admission to
neonatal intensive care unit (OR 2.01, 95%CI 0.85–4.78). Narrative
synthesis showed inconsistent data for diet outcomes, with some
evidence of reduced vitamin E and diet quality, and increased red/
processed meat consumption. FI was associated with dental
problems, maternal serum concentration of perfluoro-octane sulfonate, pre-eclampsia, depression and anxiety, but not other
organohalogen chemicals, hypertension, caesarean delivery, assisted
delivery, postpartum haemorrhage, hospital admissions, lengths of
stay, congenital anomalies, or neonatal morbidity. Mixed associations
were reported for mood disorders and community measures.
Further research in other HICs is needed to understand the
impacts of FI and maternal obesity and pregnancy health,
especially those without embedded interventions in place, to
inform policy and care requirements.
adverse health outcomes in the general population. This
systematic review and meta-analysis (PROSPERO:
CRD42022311669) explored associations between women experiencing FI in pregnancy, and maternal obesity, gestational weight
gain, and pregnancy health outcomes for both mothers and
infants.
Searches included seven databases (MEDLINE, Embase, Scopus,
Web of Science, PsychInfo, ASSIA, CINAHL) and grey literature,
reference lists, citations, and contacting authors and completed in
April 2023. We included studies in high-income countries (HICs)
reporting data on food insecurity in pregnancy from Jan 1, 2008,
onwards. Screening, data extraction, and quality assessment were
carried out by two authors independently. Random effects metaanalysis was performed when data were suitable for pooling,
otherwise narrative synthesis was conducted. Searches identified
10,515 results; 27 studies (n = 87,850 women) included: 26 from
North America, 1 from the UK. Meta-analysis showed women
experiencing FI had significantly reduced gestational weight gain
(GWG) (MD −0.37 kg 95%CI −0.58, −0.17), increased odds of
maternal obesity (OR 1.53 95%CI 1.39, 1.66), inadequate GWG (OR
1.16 95%CI 1.05, 1.28), high stress level (OR 4.07, 95%CI 1.22–13.55),
gestational diabetes (OR 1.63, 95%CI 1.36–1.95) and preterm delivery
(OR 1.21, 95%CI 1.00–1.47). There was no statistically significant
association with maternal underweight (OR 1.12 95%CI 0.89, 1.34) or
overweight (OR 1.18 95%CI 0.86, 1.50), excessive GWG (OR 1.04 95%
CI 0.96, 1.13), small for gestational age (OR 1.14, 95%CI 0.72–1.80),
large for gestational age (OR 0.90, 95%CI 0.66–1.22) or admission to
neonatal intensive care unit (OR 2.01, 95%CI 0.85–4.78). Narrative
synthesis showed inconsistent data for diet outcomes, with some
evidence of reduced vitamin E and diet quality, and increased red/
processed meat consumption. FI was associated with dental
problems, maternal serum concentration of perfluoro-octane sulfonate, pre-eclampsia, depression and anxiety, but not other
organohalogen chemicals, hypertension, caesarean delivery, assisted
delivery, postpartum haemorrhage, hospital admissions, lengths of
stay, congenital anomalies, or neonatal morbidity. Mixed associations
were reported for mood disorders and community measures.
Further research in other HICs is needed to understand the
impacts of FI and maternal obesity and pregnancy health,
especially those without embedded interventions in place, to
inform policy and care requirements.
Original language | English |
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Journal | International Journal of Obesity |
Volume | 48 |
Issue number | Supp 1 |
Publication status | Published - 23 Jan 2024 |