Association among nutrition knowledge, food frequency, and food insecurity during pregnancy

Pregnancy nutrition recommendations are aimed at maximizing the health of pregnant people and fetuses, but the ability of people to follow these recommendations may depend on their level of nutrition knowledge and their food security status. The aim of this study was to assess the nutrition knowledge of pregnant people in the U.S. and to explore relationships among pregnancy nutrition knowledge, food intake frequency, and food security. We hypothesized that lower pregnancy nutrition knowledge would be associated with less frequent intake of recommended foods and more frequent intake of foods not recommended. We also hypothesized that these relationships would be moderated by food insecurity. Finally, we hypothesized that people with food insecurity would be less likely to adhere to pregnancy nutrition recommendations, regardless of the nutrition knowledge level.

A total of 211 participants were recruited through Cloud Research survey platform. Participants completed National Health and Nutrition Examination Survey Food Frequency Questionnaire (NHANES FFQ), Pregnancy Nutrition Knowledge Questionnaire (PNKQ), and U.S. Department of Agriculture 6-item Food Security Survey with Nutrition Security questions.

Lower pregnancy nutrition knowledge and food insecurity were both associated with more frequent intake of both recommended and not recommended foods. The relationship between intake of "foods to avoid in pregnancy" and food insecurity was moderated by pregnancy nutrition knowledge, with greater nutrition knowledge associated with reductions in "foods to avoid in pregnancy" and alcohol, in particular.

Pregnant people consumed adequate amounts of recommended foods, regardless of pregnancy nutrition knowledge and food security status, but both impacted intake of "foods to avoid in pregnancy". Overall, nutrition knowledge was poor among participants. A significant observation from this study was the higher alcohol consumption among the lower pregnancy nutrition knowledge and food insecure people, highlighting the necessity to address alcohol consumption during pregnancy. Pregnancy nutrition education targeting lower socioeconomic groups could help improve adherence to nutrition recommendations in pregnant people with food insecurity. This is particularly crucial for educating about foods to avoid during pregnancy and tackling the issue of alcohol intake.