Examining the Association Between Food Insecurity and Pregnancy Outcomes

Food insecurity (FI) is a critical yet under-identified social determinant of health among pregnant populations. Prior research links FI to adverse perinatal outcomes, but few studies have examined whether these associations are modified by participation in food assistance programs such as the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study assessed the association between prenatal FI and four perinatal outcomes-postpartum depression (PPD), gestational hypertension, gestational diabetes, and gestational weight gain (GWG)-and examined whether prenatal WIC participation moderated these relationships. We conducted a cross-sectional analysis using state-representative data from Phase 8 of the Pregnancy Risk Assessment Monitoring System (PRAMS). Ten states with relevant data were included. The sample was limited to WIC-eligible mothers (income < 185% of the federal poverty level or Medicaid enrollment). Logistic regression models estimated associations between FI and each outcome in unadjusted and adjusted models, with interaction terms used to assess moderation by WIC participation. Models adjusted for sociodemographic and pregnancy-related characteristics. Among WIC-eligible mothers, 13.65% reported FI during pregnancy. After adjustment, FI was associated with higher odds of PPD (OR: 2.47, 95% CI: 2.16-2.82), gestational diabetes (OR: 1.22, 95% CI: 1.00-1.49), gestational hypertension (OR: 1.38, 95% CI: 1.18-1.60), and GWG below recommendations (OR: 1.29, 95% CI: 1.09-1.52). Adjusting for depression before and during pregnancy attenuated associations. WIC participation did not significantly moderate these relationships. Prenatal FI remains associated with adverse perinatal outcomes, suggesting that while WIC provides nutritional support, additional stressors linked to food insecurity may persist.