Food insecurity, food deserts, reproduction and pregnancy: we should alert from now

Abstract

Food insecurity and food deserts are prominent global health problems, now exacerbated by current COVID-19 pandemic. Some evidence points to the importance of food security, particularly for women in their reproductive age. Women's health and their nutrition status, across the continuum of preconception to pregnancy and postpartum are critical aspects for ensuring positive gestation course and short-/long-term outcomes by affecting essential developmental pathways. Several adverse outcomes (both maternal and neonatal) were reported in scientific literature. Screening programs, new economic policies, implementation of assistance since preconception could be a good strategy to mitigate the negative consequences of food insecurity. Potential strategies could include addressing misconceptions about healthy maternal diet and breast milk adequacy, stress management, promote social support networks, and connecting to supplemental nutrition assistance programs.

KEY POINTS

• Food insecurity (limited food access owing to cost) and desert foods (living in areas with low physical/personal access to nutritious food) are major public health concerns.

• Large geographical and within-country disparities, multiple socio-economic determinants.

• Childbearing age and pregnancy are groups at higher vulnerability to develop complications.

• Food insecurity negatively affects offspring health and development.

• Peri-conceptional window: an early clinical opportunity to screen and to apply preventive strategies.

• Help vulnerable groups to have access to more affordable nutritious food, educate and change unhealthy behaviors, adequate stress management, social support networks.

Keywords:

• Food insecurity
• food desert
• periconceptional
• pregnancy outcomes
• breastfeeding
• adulthood

Editorial

Relationships between food insecurity, food deserts and reproductive effects, pregnancy outcomes and neonatal, childhood and adulthood sequelae have received increasing interest in research in the last years. According to the Food and Agricultural Organization (FAO) – World Health Organization (WHO) report in 2018, an increasing trend in the occurrence of severe food insecurity (FI) is clear worldwide, with rates of FI shifted from 8.3% in 2014 to 10.2% in 2017 [1].

By definition, food insecurity occurs “when people lack secure access to sufficient amounts of safe and nutritious food for normal growth and development and an active and health life” [2].

Regarding the definition of food deserts, this expression refers to areas where people have limited access to a variety of nutritious food, due to having a limited income and/or living far away from sources of healthy food. The United States Department of Agriculture (USDA) elaborated few parameters in its investigations to determine whether an area had limited access to nutritious food [3]. Thus, FI and food deserts are strictly linked, often depending each others: people tend to make nutritional choices based on their psycho-socio-economic status and on what is available where they live; in food deserts there is often a high density of fast-food restaurants and corner stores that offer unhealthy prepared and processed foods at low price.

The negative impact of food insecurity and food deserts is mainly observed in more vulnerable groups. A large heterogeneity in geographical areas, including both low income and high income countries, and socio-economics differences were described in literature. The report from the FAO in 2019 indicated a higher prevalence of moderate/severe FI among women [4], and other researches underlined the negative impact of FI especially on women of fertile age, and thus also on their reproductive outcomes [5,6].

Reached an optimal health status is desirable in the pre-conceptional period: having an adequate pre-pregnancy body mass index (BMI) and a safe dietary intake (included all essential macro- and micronutrients, vitamins, minerals) are key points when a pregnancy is planned. In addition, nutritional and financial needs increase during pregnancy, making pregnant women particularly vulnerable to food insecurity.

A growing body of scientific researches confirm how the limited access to food, poor dietary intake should influence the fertility status, increase the risk of clinical complications during pregnancy, post-partum period, breastfeeding and should predispose newborns to a short- and long-term sequelae. Moreover, food insecure pregnant women were likely to have future additional risks for adverse health outcomes, including cardiometabolic complications, overweight, psychological vulnerability/mental disorders.

Others authors documented associations between FI, living in food deserts and adverse pregnancy outcomes, including maternal anemia, gestational diabetes mellitus, pregnancy-induced hypertension disorders, low birth weight, pre-labor rupture of membranes, preterm birth, newborn impaired cognitive development, newborn mortality [6–9].

Moreover, a recent multicenter case–control study protocol investigated the association with fetal structural anomalies, reporting a positive association with FI [10].

Regarding the relationship with preterm delivery, Castillo-Chavez et al. carried out a case–control study that observed the association between food security and hearing disorders in premature newborns, reporting relevant hearing problems related to FI [11].

Carmichael et al. reported that food insecurity during pregnancy was associated with neonatal abnormalities (i.e. transposition of the great vessels at the base of the heart, tetralogy of Fallot, spina bifida and cleft palate) [12]. Campbell et al. described an association of FI with neonatal mortality [13].

Food insecurity was also associated with an increased risk of vertical Human Immune Deficiency Virus (HIV) transmission in newborns due to a suboptimal virologic non-suppression in women on antiretroviral treatment [14]. A recent systematic review and meta-analysis confirmed a high prevalence and positive association with FI among pregnant women with HIV/AIDS, which suggests the need for food security assessments in HIV/AIDS clinical setting [15].

Interestingly, the relationship between food insecurity and breastfeeding has also been explored. Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. Orr et al. analyzed how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfeed infants in Canada, showing how FI mothers were less able than women with food security to sustain exclusive breastfeeding [16]. Similarly, Dinour et al. investigated the link between prenatal food insecurity and breastfeeding initiation and early cessation (< 10 weeks) among American population [17]. It is crucial to detect food insecure mothers during breastfeeding in order to prevent micronutrients deficiencies in babies.

The current COVID-19 pandemic has exacerbated the crisis of food insecurity across the world, disproportionally affecting women and racial and ethnic minorities; prenatal care represents an early, clinical opportunity to identify families at risk [18,19].

It is important to screen women for FI and food deserts by using available specific questionnaires and scales, such as the Household Food Security Scale (HFSS), Household Food Insecurity Access Scale (HFIAS), Individually Focused Food Insecurity Access Scale (IFIAS), Brazilian Food Insecurity Scale (EBIA), and/or others [6].

In conclusion, mitigating the potential harmful effects of adverse socioeconomic conditions is critical to promoting optimal health and development throughout the entire life course. However, several relevant areas and research gaps for improving women's food security before and during pregnancy remain. It is essential to prioritize preconception nutrition and facilitate access to health and family planning services.

Potential strategies could include addressing misconceptions about healthy maternal diet and breast milk adequacy, providing stress management, creation of social support networks, and developing supplemental nutrition assistance programs. Further research is needed to achieve higher food security for everyone and everywhere.

Disclosure statement

No potential conflict of interest was reported by the author(s).