Food desert residence and prenatal diet quality

Suboptimal prenatal nutrition is associated with adverse pregnancy outcomes, yet the contribution of the lived food environment on prenatal diet quality remains incompletely understood. This study evaluated differences in prenatal macro- and micronutrient intake, glycemic and lipid intake patterns, and dietary quality indices among pregnant individuals living in food desert (FD) versus non-FD areas.

This secondary analysis utilized data from an urban maternal-child cohort enrolled between 2014 and 2024. Eligible participants were aged 18-40 years, had a singleton pregnancy at 8-14 weeks' gestation at enrollment, and self-identified as Black/African American. Dietary intake was assessed using the Block-Bodnar food frequency questionnaires (FFQs) administered at 8-14 or 24-30 weeks' gestation, and responses were utilized to calculate dietary intake measures. FD exposure status was assigned by geocoding participants' primary residential address to census tract-level US Department of Agriculture FD classifications, with FD defined as a census tract meeting criterion for (1) low income AND (2) low access (at least 500 people or 33% of residents living farther than 1 mile from the nearest supermarket or large grocery store in an urban area or 10 miles in rural areas). Descriptive statistics were used to compare dietary intake by FD exposure. Primary outcomes of macronutrient (protein, carbohydrates, fat) and micronutrient (vitamin and mineral) intake were analyzed as continuous variables. Secondary outcomes included dietary glycemic indices, lipid indices, and five dietary scores including Healthy Eating Index 2015 (HEI 2015), Alternate Healthy Eating Index for Pregnancy (AHEI-P), Dietary Approach to Stop Hypertension (DASH), Dietary Inflammatory Index (DII), and Mediterranean Diet (MED) score. Multivariable linear regression models were used to evaluate associations between FD residence and dietary outcomes, adjusting for maternal age, education level, insurance status, first-trimester body mass index (BMI), parity, and total energy (caloric) intake.

Of 543 pregnant participants, 242 (45%) resided in FDs. Median BMI (kg/m²) was similar between FD and non-FD groups (28.0 vs. 27.0; p = 0.32). In both bivariate and adjusted analyses, FD residence was not associated with significant differences in macro- or micronutrient intake, or glycemic or lipid dietary patterns. Adjusted analysis of diet quality food scores revealed a significant association of FD residence and higher pro-inflammatory DII scores (β = 0.51; 95% CI, 0.27-0.98; p = 0.04). Across both geographic groups, median intake of protein and several key micronutrients (iron, folic acid, and vitamin D) fell below the recommended intake in pregnancy, even when accounting for supplement intake. Dietary patterns in both groups were characterized by high intake of total sugar and saturated fats, and low-to-moderate adherence to dietary guidelines.

In this urban Black/African American cohort, prenatal dietary quality was suboptimal regardless of FD residence. Pregnant individuals in both FD and non-FD areas demonstrated insufficient intake of protein and critical micronutrients, as well as dietary indices associated with adverse glycemic indicators, lipid profiles, and inflammation. These findings underscore the need for comprehensive, pregnancy-centered nutrition strategies that address structural, behavioral, and clinical determinants of diet beyond geographic food access alone. Future research should explore nuanced determinants of diet quality among diverse populations and test innovative public health interventions that extend beyond traditional FD paradigms.