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Am J Perinatol 2023; 40(08): 825-832
DOI: 10.1055/s-0041-1740194
Clinical Opinion

Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

Helen Gomez 
1   Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
,
Julia D. DiTosto
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Charlotte M. Niznik
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Lynn M. Yee
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding This project was supported by the NICHD R21 HD094271–01 and NIDDK R34 DK125958–01. Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
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Abstract

Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation.

Key Points

  • Research on food insecurity and diabetes-related health is limited.

  • The impact of food security on diabetes management and obstetric outcomes is likely significant.

  • Future work to evaluate perinatal food security screening is warranted.

Keywords

food security - food environment - gestational diabetes mellitus - medical nutrition therapy - pregnancy - type 2 diabetes mellitus


Publication History

Received: 28 May 2021

Accepted: 03 October 2021

Article published online:
28 November 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 CDC. Gestational diabetes. May 30, 2019. Accessed December 31, 2020 at: https://www.cdc.gov/diabetes/basics/gestational.html
    PubMedGoogle Scholar
  • 2 Casagrande SS, Linder B, Cowie CC. Prevalence of gestational diabetes and subsequent type 2 diabetes among U.S. women. Diabetes Res Clin Pract 2018; 141: 200-208
    CrossrefPubMedGoogle Scholar
  • 3 Zhou TS, D. L., Xiang H, Yoriko N, Hoirun H, Gang, X. S. P, Xiayun S, Qi L. (2018). Prevalence and Trends in Gestational Diabetes Mellitus among Women in the United States, 2006–2016. Am Diabetes Assoc
    PubMedGoogle Scholar
  • 4 American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 201: pregestational diabetes mellitus. Obstet Gynecol 2018; 132 (06) e228-e248
    CrossrefPubMedGoogle Scholar
  • 5 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
    CrossrefPubMedGoogle Scholar
  • 6 DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11 (E104): E104
    CrossrefPubMedGoogle Scholar
  • 7 Hedderson MM, Darbinian JA, Ferrara A. Disparities in the risk of gestational diabetes by race-ethnicity and country of birth. Paediatr Perinat Epidemiol 2010; 24 (05) 441-448
    CrossrefPubMedGoogle Scholar
  • 8 Hedderson M, Ehrlich S, Sridhar S, Darbinian J, Moore S, Ferrara A. Racial/ethnic disparities in the prevalence of gestational diabetes mellitus by BMI. Diabetes Care 2012; 35 (07) 1492-1498
    CrossrefPubMedGoogle Scholar
  • 9 ACOG Committee Opinion No. 649: racial and ethnic disparities in obstetrics and gynecology. Obstet Gynecol 2015; 126 (06) e130-e134
    CrossrefPubMedGoogle Scholar
  • 10 Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care 2002; 25 (03) 608-613
    CrossrefPubMedGoogle Scholar
  • 11 Rothman R, Malone R, Bryant B, Horlen C, DeWalt D, Pignone M. The relationship between literacy and glycemic control in a diabetes disease-management program. Diabetes Educ 2004; 30 (02) 263-273
    CrossrefPubMedGoogle Scholar
  • 12 Yee LM, McGuire JM, Taylor SM, Niznik CM, Simon MA. Social and environmental barriers to nutrition therapy for diabetes management among underserved pregnant women: a qualitative analysis. J Nutr Educ Behav 2016; 48 (03) 170-80.e1
    CrossrefPubMedGoogle Scholar
  • 13 Coleman-Jensen A, Rabbitt M, Gregory C. Food Security Status of U.S. Households in 2019. US Department of Agriculture; 2020
    Google Scholar
  • 14 Barrett, Christopher B. “Measuring Food Insecurity.” Science, vol. 327, no. 5967, American Association for the Advancement of Science. 2010: 825-828
    PubMedGoogle Scholar
  • 15 Nord M, Andrews M, Carlson S. Household Food Security in the United States, 2007: Economic Research Report Number 66. United States Department of Agriculture Economic Research Service; 2008
    PubMedGoogle Scholar
  • 16 Wetherill MS, White KC, Rivera C. Food insecurity and the nutrition care process: practical applications for dietetics practitioners. J Acad Nutr Diet 2018; 118 (12) 2223-2234
    CrossrefPubMedGoogle Scholar
  • 17 Coleman-Jensen A, Rabbitt MP, Hales A, Gregory CA. Food security in the U.S.: history & background. Accessed October 19, 2020 at: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/history-background/
    PubMedGoogle Scholar
  • 18 Wilde P. The Uses and Purposes of the USDA Food Security and Hunger Measure: A Report for the Committee on National Statistics Panel on Food Security Measurement. Washington, DC: National Academies; 2004
    Google Scholar
  • 19 Hamilton W, Cook JT, Thompson WW. et al. Household Food Security in the United States in 1995: Summary Report of the Food Security Measurement Project. Alexandria, VA: Food and Consumer Service; 1997
    Google Scholar
  • 20 Morland K, Wing S, Diez Roux A. The contextual effect of the local food environment on residents' diets: the atherosclerosis risk in communities study. Am J Public Health 2002; 92 (11) 1761-1767
    CrossrefPubMedGoogle Scholar
  • 21 Booth SL, Sallis JF, Ritenbaugh C. et al. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutr Rev 2001;59(3, Pt 2):S21–S39, discussion S57–S65
    PubMedGoogle Scholar
  • 22 Coleman-Jensen A, Rabbitt MP, Hales A, Gregory CA. Food security in the US: measurement. Accessed January 28, 2021 at: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/measurement/
    PubMedGoogle Scholar
  • 23 Economic Research Service, USDA. U.S. Household Food Security Survey Module: Three-Stage Design, with Screeners. Accessed November 2, 2020 at: https://www.ers.usda.gov/media/8271/hh2012.pdf
    PubMedGoogle Scholar
  • 24 Hromi-Fiedler A, Bermúdez-Millán A, Segura-Pérez S, Damio G, Pérez-Escamilla R. Adaptation of the U.S. Food Security Survey Module for low-income pregnant Latinas: qualitative phase. J Hunger Environ Nutr 2009; 4 (01) 62-80
    CrossrefPubMedGoogle Scholar
  • 25 Blumberg SJ, Bialostosky K, Hamilton WL, Briefel RR. The effectiveness of a short form of the Household Food Security Scale. Am J Public Health 1999; 89 (08) 1231-1234
    CrossrefPubMedGoogle Scholar
  • 26 Economic Research Service, USDA. U.S. Household Food Security Survey Module: Six-Item Short Form. Accessed November 2, 2020 at: https://www.ers.usda.gov/media/8282/short2012.pdf
    PubMedGoogle Scholar
  • 27 Coleman-Jensen A, Rabbitt M, Gregory C. Survey Tools. US Department of Agriculture; 2020
    Google Scholar
  • 28 Bodor JN, Rice JC, Farley TA, Swalm CM, Rose D. The association between obesity and urban food environments. J Urban Health 2010; 87 (05) 771-781
    CrossrefPubMedGoogle Scholar
  • 29 Richardson AS, Boone-Heinonen J, Popkin BM, Gordon-Larsen P. Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum. BMJ Open 2012; 2 (02) e000698
    CrossrefPubMedGoogle Scholar
  • 30 Torloni MR, Betrán AP, Horta BL. et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10 (02) 194-203
    CrossrefPubMedGoogle Scholar
  • 31 Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, Kushel MB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. J Gen Intern Med 2007; 22 (07) 1018-1023
    CrossrefPubMedGoogle Scholar
  • 32 Nelson K, Cunningham W, Andersen R, Harrison G, Gelberg L. Is food insufficiency associated with health status and health care utilization among adults with diabetes?. J Gen Intern Med 2001; 16 (06) 404-411
    CrossrefPubMedGoogle Scholar
  • 33 Abdurahman AA, Chaka EE, Nedjat S, Dorosty AR, Majdzadeh R. The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis. Eur J Nutr 2019; 58 (04) 1341-1350
    CrossrefPubMedGoogle Scholar
  • 34 Hutchinson PL, Nicholas Bodor J, Swalm CM, Rice JC, Rose D. Neighbourhood food environments and obesity in southeast Louisiana. Health Place 2012; 18 (04) 854-860
    CrossrefPubMedGoogle Scholar
  • 35 Laraia BA, Siega-Riz AM, Kaufman JS, Jones SJ. Proximity of supermarkets is positively associated with diet quality index for pregnancy. Prev Med 2004; 39 (05) 869-875
    CrossrefPubMedGoogle Scholar
  • 36 Tipton MJ, Wagner SA, Dixon A, Westbay L, Darji H, Graziano S. Association of living in a food desert with pregnancy morbidity. Obstet Gynecol 2020; 136 (01) 140-145
    CrossrefPubMedGoogle Scholar
  • 37 Laraia BA, Siega-Riz AM, Gundersen C. Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. J Am Diet Assoc 2010; 110 (05) 692-701
    CrossrefPubMedGoogle Scholar
  • 38 Yee LM, McGuire JM, Taylor SM, Niznik CM, Simon MA. “i was tired of all the sticking and poking”: identifying barriers to diabetes self-care among low-income pregnant women. J Health Care Poor Underserved 2015; 26 (03) 926-940
    CrossrefPubMedGoogle Scholar
  • 39 Kahr MK, Suter MA, Ballas J. et al. Geospatial analysis of food environment demonstrates associations with gestational diabetes. Am J Obstet Gynecol 2016; 214 (01) 110.e1-9
    CrossrefPubMedGoogle Scholar
  • 40 Janevic T, Borrell LN, Savitz DA, Herring AH, Rundle A. Neighbourhood food environment and gestational diabetes in New York City. Paediatr Perinat Epidemiol 2010; 24 (03) 249-254
    CrossrefPubMedGoogle Scholar
  • 41 Young C, Laurent O, Chung JH, Wu J. Geographic distribution of healthy resources and adverse pregnancy outcomes. Matern Child Health J 2016; 20 (08) 1673-1679
    CrossrefPubMedGoogle Scholar
  • 42 Fonge YN, Jain VD, Harrison C, Brooks M, Sciscione AC. Examining the relationship between food environment and gestational diabetes. Am J Obstet Gynecol MFM 2020; 2 (04) 100204
    CrossrefPubMedGoogle Scholar
  • 43 Banner GC, Weaver KN, Rushovich T, York SL, Yee LM. Association between food deserts and gestational diabetes mellitus in a large metropolitan area. Am J Perinatol 2021; 38 (S 01): e39-e45
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Battarbee AN, Yee LM. Association of fast food and supermarket density with neonatal outcomes of pregnancies affected by gestational diabetes. Am J Perinatol 2019; 36 (13) 1405-1411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677): 1773-1779
    CrossrefPubMedGoogle Scholar
  • 46 Ades V, Goddard B, Pearson Ayala S, Chemouni Bach S, Wu SX. ACOG Committee Opinion No. 729: importance of social determinants of health and cultural awareness in the delivery of reproductive health care. Obstet Gynecol 2018; 131 (06) 1162-1163
    CrossrefPubMedGoogle Scholar
  • 47 Gottlieb L, Sandel M, Adler NE. Collecting and applying data on social determinants of health in health care settings. JAMA Intern Med 2013; 173 (11) 1017-1020
    CrossrefPubMedGoogle Scholar
  • 48 Yee LM, Simon MA, Grobman WA, Rajan PV. Pregnancy as a “golden opportunity” for patient activation and engagement. Am J Obstet Gynecol 2021; 224 (Suppl. 01) 116-118
    CrossrefPubMedGoogle Scholar
  • 49 Ridberg RA, Marpadga S, Akers MA, Bell JF, Seligman HK. Fruit and vegetable vouchers in pregnancy: preliminary impact on diet & food security. J Hunger Environ Nutr 2021; 16 (Suppl. 02) 149-163
    CrossrefPubMedGoogle Scholar
  • 50 Heberlein EC, Frongillo EA, Picklesimer AH, Covington-Kolb S. Effects of group prenatal care on food insecurity during late pregnancy and early postpartum. Matern Child Health J 2016; 20 (05) 1014-1024
    CrossrefPubMedGoogle Scholar
  • 51 FAO. World Food Summit: 13–17 November 1996, Rome, Italy. January 13, 1996. Accessed November 2, 2020 at: https://www.fao.org/3/w3613e/w3613e00.htm
    PubMedGoogle Scholar
  • 52 Anderson S. Core indicators of nutritional state for difficult-to-sample populations. J Nutr 1990; 120 (Suppl. 11) 1559-1600
    PubMedGoogle Scholar
  • 53 Economic Research Service, USDA. U.S. adult food security survey module: three-stage design, with screeners. Accessed November 2, 2020 at: https://www.ers.usda.gov/media/8279/ad2012.pdf
    PubMedGoogle Scholar
  • 54 US Census Bureau. SIPP 2008 Panel Wave 16 Core Questionnaire. Accessed November 2, 2020 from: https://www2.census.gov/-programs-surveys/sipp/questionnaires/2008/sipp-2008-panelwave-16-core-questionnaire.pdf
    PubMedGoogle Scholar