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eISSN: 2373-4310

Nutritional Health & Food Engineering

Mini Review Volume 7 Issue 4

Food insecurity during the gestational period and factors associated with maternal and child health 

Alanderson Alves Ramalho,1 Fernanda Andrade Martins,1 Rosalina Jorge Koifman2

1Center of Health Sciences and Sports, Federal University of Acre, Brazil
2National School of Public Health, Oswaldo Cruz Foundation, Brazil

Correspondence: Alanderson Alves Ramalho,Center of Health Sciences and Sports, Federal University of Acre, Campus Universitário-BR 364, Km 04 -Distrito industrial-CEP: 69.920-900, Rio Branco, Acre, Brazil

Received: June 17, 2017 | Published: December 13, 2017

Citation: Ramalho AA, Martins FA, Koifman RJ. Food insecurity during the gestational period and factors associated with maternal and child health. J Nutr Health Food Eng. 2017;7(4):337-343. DOI: 10.15406/jnhfe.2017.07.00245

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Abstract

Food security consists in granting everyone’s right to regular and permanent access to safe, nutritious and sufficient food to meet their dietary needs and food preferences in order to lead to an active and healthy life. Studies that analyze aspects associated with food insecurity are important for the planning of programs and public policies in a preventive way and health promotion. The objective of this study is to review the factors associated with food insecurity during pregnancy. The prevalence of food insecurity in women during the gestational period ranged from 9.0% to 87.9%, with the lowest prevalence found in developed countries and the highest prevalence in underdeveloped or developing countries.

Keywords: food security, food and nutrition security, pregnancy, women's health, prenatal care

Introduction

Food security consists in granting everyone’s right to regular and permanent access to safe, nutritious and sufficient food to meet their dietary needs and food preferences in order to lead to an active and healthy life.1

The main international measure to achieve food security is based on the first United Nations Millennium Development Goals (eradicate hunger and poverty),2 concurrent with the human right to proper food. It is estimated that one billion people in the world do not have access to sufficient food to meet basic nutritional needs or that they live in a situation of continuous hunger, a situation that indicates a severe food insecurity.3 Food security / insecurity can be measured through individual dietary intake, anthropometry, food availability, among others. In international surveys the most used instrument to measure this insecurity is the "Household Food Security Survey Module".

According to the UN Food and Agriculture Organization report,4 the prevalence of food insecurity in the world has improved, from 18.6% between 1990 and 1992 to 12.5% between 2010 and 2012. Food insecurity is determined mainly by poverty and social inequalities. Studies that analyze aspects associated with food insecurity are important for the planning of programs and public policies in a preventive way and health promotion.4,5 The objective of this study is to review the factors associated with food insecurity during pregnancy.

Food insecurity during the gestational period

The effects of food insecurity can be seen mainly among the most vulnerable groups. Infant mortality, the damage of physical and mental development, low birth weight, maternal mortality, increased school dropouts, and decreased school performance are events related to the lack of healthy and quality food as a consequence of precarious access to income, goods and services.6 Several international studies point to a direct relationship between food insecurity and losses in the children nutritional status.7–11

Laraia et al.,12 have proposed three potential reasons why food insecurity may be of particular importance in pregnancy: nutritional needs are increased due to physiological changes in the pregnant woman's organism (elevation of basal metabolic rate as a consequence of accelerated synthesis of fetal, placental, uterine, mammary and maternal reserve tissue; the increase in mass of metabolically active tissue and cardiorespiratory process), the effort required to prepare food may be more difficult and pregnant women are forced to leave work, especially at the end of pregnancy, which leads to financial squeezing. These reasons may influence nutrition, health conditions and nutritional maternal status and may have unsatisfactory pregnancy outcomes.12

In this review the prevalence of food insecurity in women during the gestational period ranged from 9.0% to 87.9% (Table 1), with the lowest prevalence found in developed countries and the highest prevalence in underdeveloped or developing countries.12–28

Authors / year of publication

Place of study

Study period

Population (source of information)

Study design

Sample size

Measurement instrument (Scale)*

Prevalence of food insecurity

Statistical analysis

Associated factors

Araujo et al.13

Recife - PE, Brazil

Nov 2012 to Jan 2013

Pregnant women attended by three Family Health Units (USF) located in districts II and III

Cross sectional

88

EBIA, 15 items

71.59% (mild: 54.55%, moderate: 13.64%, severe: 3.41%)

Simple logistic regression

association with no own income: OR=3.33

Dewing et al.14

South Africa

 

Women 3 months after childbirth residents in a peri-urban settlement near Cape Town, South Africa.

Cross sectional

249

HFIAS, 9 items

Severe insecurity: 59.8%

Multiple Poisson regression

Each additional point on the food insecurity scale was associated with increased risks of probable depression (adjusted risk ratio [ARR], 1.05; 95% CI, 1.02–1.07), hazardous drinking (ARR, 1.04; 95% CI, 1.00–1.09), and suicidality (ARR, 1.12; 95% CI, 1.02–1.23). Evaluated at the means of the covariates, these estimated associations were large in magnitude.

Gamba et al.15

United States of America

1999 to 2008

Pregnant women participating in NHANES

Cross sectional

1158

US HFSSM, 18 items

21,00%

Multiple logistic regression

Household food security status may not be associated with overall diet quality.

Hromi-Fiedler et al.16

Hartford - Connecticut, USA

Sept 2005 to May 2007

Pregnant Latinas of Low Income Residents in Hartford

Cross sectional

135

Adapted version for pregnant Latinas: 15 items from US HFSSM

36,80%

Multiple logistic regression

Association with high levels of depressive symptoms (OR=2.59, 95% CI: 1.03-5.52)

Jebena et al.17

Ethiopia

2013

Pregnant women from Jimma Zone, Southwest Ethiopia

Cross sectional

642

HFIAS, 9 items

9,00%

Multiple logistic regression

Association with mental distress (OR=4.15, 95% CI: 1.67-10.32).

Laraia et al.12

North Carolina, United States

2000 to 2004

Pregnant women with less than 20 gestational weeks attended at University of North Carolina Hospitals and private obstetrics clinics

Retrospective cohort

606

US HFSSM, 18 items

25%

Multiple logistic regression

Association with: poorer social class (OR=4.84; 95% CI: 2.37- 8.75); black skin color (OR=1.65, 95% CI: 1.05 - 2.61); increase in the perceived stress score (OR=1.80; 95% CI: 1.43 - 2.25); increase in anxiety score (OR=1.74, 95% CI: 1.38- 2.19); increase in the score of symptoms of depression (OR = 1.59, 95% CI: 1.27 - 2.00)

Laraia et al.18

North Carolina, United States

Jan 2001 to May 2005

Pregnant women with income ≤ 400% of the income / poverty index served at University of North Carolina Hospitals and private obstetrics clinics

Retrospective cohort

810

US HFSSM, 18 items

24%

Multiple logistic regression

Association with severe pre-gestational obesity (OR= 2.97; 95% CI: 1.44-6.14); gestational diabetes (OR= 2.76, 95% CI: 1.01-7.66)

Lobo19

João Pessoa - PB, Brazil

Jun to Aug 2013

Parturients from 19 to 35 years of age in two public

Cross sectional

222

EBIA, 14 items

59% (mild: 43.2%, moderate: 9.0%, severe: 6.8%)

Simple logistic regression

Inverse association: regular consumption of raw salad: OR = 0.79 (95% CI: 0.68-0.93); Cooked veggies: OR= 0.87 (95% CI: 0.76 -0.99); fresh fruit or fruit salad: OR = 0.64 (95% CI: 0.48-0.84).

López-Salame et al.20

Cartagena, Colombia

2011

Pregnant women in the urban area served in Cartagena

Cross sectional

413

Adapted and validated Alvarez scale of CCHIP

29.8% (mild: 23%, moderate: 6.3%, severe: 0.5%)

Simple logistic regression

-

Marano et al.21

Queimados e Petrópolis - RJ, Brazil

Dec 2007 to Nov 2008

Women in the first trimester of pregnancy attended by the public health system

Cross sectional

1535

EBIA, 15 items

37.8% (mild: 22.9%, moderate and severe: 14.9%)

Simple logistic regression

Mild insecurity associated with obesity (OR= 1.49, 95% CI: 1.01-2.20)

Na et al.22

Gaibandha District, Bangladesh

2007 to 2011

Rural women, followed by the 5 gestational week at 6 months postpartum

Prospective cohort

14600

FAST, 9 items

49.65% (mild: 20.12%, moderate: 15.33%, severe: 14.20%)

Generalized estimation equations (GEE)

Compared with women fromfood-secure households, women of mild, moderate, and severe HFI were less likely, in a dose-response fashion, to have consumed dairy products [adjusted ORs (95% CIs): 0.73 (0.69, 0.78), 0.62 (0.58, 0.66), and 0.52 (0.48, 0.55), respectively], eggs [0.81 (0.76, 0.85), 0.73 (0.68, 0.77), and 0.61 (0.57, 0.65)], meat [0.83 (0.79, 0.88), 0.73 (0.69, 0.78), and 0.60 (0.56, 0.64)], fish [0.87 (0.80, 0.94), 0.76 (0.70, 0.83), and 0.59 (0.54, 0.65)], legumes and nuts [0.88 (0.83, 0.93), 0.81 (0.76, 0.87), and 0.79 (0.74, 0.85)], and yellow and orange fruit and vegetables [0.85 (0.80, 0.91), 0.78 (0.73, 0.84), and 0.72 (0.67, 0.78)]. Neither intakes of dark-green leafy vegetables nor of vegetable oil were associated with HFI status.

Oliveira et al.23

Maceió - AL, Brazil

2014

Pregnant women from Maceió who performed prenatal care in the municipal public health system

Cross sectional

363

EBIA, 14 items

42.7% (mild: 24.8%, moderate: 9.99%, severe: 8.0%)

Multiple Poisson regression

Association with hyperglycaemia: PR: 1.45 (95% CI: 1.01- 2.12); high blood pressure: RP: 1.64 (95% CI: 1.04-2.56);

Park et al.24

United States of America

1999 to 2006

Pregnant women participating in NHANES

Cross sectional

1045

US HFSSM, 18 items

15,69%

Multiple logistic regression

Association with iron deficiency classified by ferritin (OR= 2.90, 95% CI: 1.29 - 6.51) adjusted for age, race, gestational trimester, parity, schooling, year of research, poverty index, smoking, health insurance coverage, and protein level C-reactive

Santos25

Santo Antônio de Jesus, BA, Brazil

Feb 2014 to Feb 2015

Pregnant women from 14 to 49 residents in the urban area and attended at the Family Health Units of the municipality

Cross sectional

245

USDA Short Food Security Scale - 6 items

28,16%

Multiple logistic regression

Association with anemia (OR=3.46, 95% CI: 1.78-6.75), adjusted for marital status, paid work, number of residents at home and level of schooling

Stevens et al.26

Pirganj, Bangladesh

Feb 2013 to Feb 2015

Pregnant women from twelve villages in Pirganj sub-district, Rangpur district, in northern Bangladesh.

Cross sectional

288

HFIAS, 9 items

87.9% (mild: 20.6%, moderate: 59.6%, severe: 7.7%)

Chi-square

Food security was associated with seasonality (p= 0.039). Food diversity was significantly lower in the summer (p= 0.029) and spring (p=0.038). Food security decreased significantly in the spring (p=0.006) and at the end of autumn (p=0.009).

Tabares et al.27

Pereira - Risaralda, Colombia

2009

Pregnant adolescents who had prenatal care in the three institutions providing health services belonging to "ESE Salud Pereira"

Cross sectional

150

ELCSA, 17 items

63.3% (mild: 23.3%, moderate: 17.3%, severe: 22.7%)

Chi-square

Association with lower socioeconomic status (p=0.016)

Zapata-López et al.28

Medellín, Colombia

Aug 2011 to Mar 2012

Pregnant women in the third trimester of pregnancy who underwent prenatal care in the Mendellin public health service

Cross sectional

294

ELCSA, 17 items

65.4% (mild: 42.2%, moderate: 14.5%, severe: 8.7%)

Multiple logistic regression

-

Table 1 Summary of studies that estimated the prevalence and factors associated with food insecurity during pregnancy

*CCHIP: Community Childhood Hunger Identification Project; EBIA: Brazilian Food Insecurity Scale; ELCSA: Latin American and Caribbean Food Security Scale; HFIAS: Household Food Insecurity Access Scale; US HFSSM: US Household Food Security Survey Module

Although there are some studies on food insecurity during the gestational period, there is still little knowledge about the effects of this insecurity on maternal and child health. Food insecurity in the gestational period is associated with anemia, pre-gestational and gestational anthropometric nutritional status, birth defects, maternal depression/anxiety disorders in pregnancy, gestational complications (diabetes, hypertension and obesity), gestational weight gain, food intake, low birth weight and postpartum depression and suicide. The key determinants of food insecurity were the non-empowerment of women, the presence of women and children at home, polygamous family arrangements, maternal depression disorder, lower education level, depressive disorder symptoms, paternal absence, low income, black race, and maternal age.10,12,14,18,20,21,24,28–38

More studies are needed to understand the impact of gestational food insecurity on maternal and child health in order to contribute to the development of health policies that can guarantee the food and nutritional security of the binomial mother and child.

Conclusion

The prevalence of food insecurity in women during the gestational period ranged from 9.0% to 87.9%, with the lowest prevalence found in developed countries and the highest prevalence in underdeveloped or developing countries, and this prevalence is associated with anemia, pre-gestational and gestational anthropometric nutritional status, birth defects, maternal depression/anxiety disorders in pregnancy, gestational complications (diabetes, hypertension, obesity), gestational weight gain, food intake, low birth weight and postpartum depression and suicide.

Acknowledgements

This study received financial support from FAPAC (Programa Pesquisa para o SUS Edital MS/CNPq/Decit/SCTIE/FAPAC 2013).

Conflict of interest

The author declares no conflict of interest.

References

  1. World Food Summit Plan of Action. Italy: FAO, Rome Declaration on World Food Security; 1996.
  2. The Millennium Development Goals Report 2010. USA: United Nations; 2010.
  3. Estado de la inseguridad alimentaria en el mundo:¿Cómo afecta la volatilidad de los precios internacionales a las economías nacionales y la seguridad alimentaria? Food and Agriculture Organization of the United Nations; 2011.
  4. The state of food insecurity in the world: Strengthening the enabling environment for food security and nutrition. Italy: FAO; 2014. 52 p.
  5. Panigassi G, Segall–Corrêa AM, Marin–León L, et al. Food insecurity as an indicator of inequity: analysis of a population survey. Cad Saude Publica. 2008;24(10):2376–2384.
  6. Campbell CC. Food insecurity: a nutritional outcome or a predictor variable? J Nutr. 1991;121(3):408–415.
  7. Rose D, Nicholas Bodor J. Household Food Insecurity and Overweight Status in Young School Children: Results from the Early Childhood Longitudinal Study. Pediatrics. 2006;117(2):464–473.
  8. Gundersen C, Garasky S, Lohman BJ. Food Insecurity Is Not Associated with Childhood Obesity as Assessed Using Multiple Measures of Obesity. J Nutr. 2009;139(6):1173–1178.
  9. Hackett M, Melgar–Quiñonez H, Álvarez MC. Household food insecurity associated with stunting and underweight among preschool children in Antioquia, Colombia. Rev Panam Salud Pública. 2009;25(6):506–510.
  10. Ivers LC, Cullen KA. Food insecurity: special considerations for women. Am J Clin Nutr. 2011;94(6):1740S–1744S.
  11. Ramalho AA, Mantovani SAS, Oliart–Guzman H, et al. Food insecurity in families with children under five years of age on the Brazil–Peru Amazon border. J Hum Growth Dev. 2016;26(3):307.
  12. Laraia BA, Siega–Riz AM, Gundersen C, et al. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136(1):177–182.
  13. Araújo AA, Santos ACO. In Segurança alimentar e indicadores socioeconômicos de gestantes dos distritos sanitários II e III, Recife–Pernambuco. Rev De APS. 2016;19(3):466–475.
  14. Dewing S, Tomlinson M, le Roux IM, et al. Food insecurity and its association with co–occurring postnatal depression, hazardous drinking, and suicidality among women in peri–urban South Africa. J Affect Disord. 2013;150(2):460–465.
  15. Gamba R, Leung CW, Guendelman S, et al. Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999–2008. Matern Child Health J. 2016;20(11):2348–2356.
  16. Hromi–Fiedler A, Bermúdez–Millán A, Segura–Pérez S, et al. Household food insecurity is associated with depressive symptoms among low–income pregnant Latinas: Food insecurity and prenatal depressive symptoms. Matern Child Nutr. 2011;7(4):421–430.
  17. Jebena MG, Taha M, Nakajima M, et al. Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design. BMC Pregnancy Childbirth. 2015;15(1):250.
  18. 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(5):692–701.
  19. Lobo IKV. Coorte de nascimentos de João Pessoa: efeitos da insegurança alimentar na saúde materno infantil. Universidade Federal da Paraíba; 2014.
  20. López–Sáleme R, Díaz–Montes C, Bravo–Aljuriz L, et al. Seguridad alimentaria y estado nutricional de las mujeres embarazadas en Cartagena, Colombia, 2011. Rev Salud Pública. 2011;14(2):200–212.
  21. Marano D, Gama SGN da, Domingues RMSM, et al. Prevalence and factors associated with nutritional deviations in women in the pre–pregnancy phase in two municipalities of the State of Rio de Janeiro, Brazil. Rev Bras Epidemiolgia. 2014;17(1):45–58.
  22. Na M, Mehra S, Christian P, et al. Maternal Dietary Diversity Decreases with Household Food Insecurity in Rural Bangladesh: A Longitudinal Analysis. J Nutr. 2016;146(10):2109–2116.
  23. Oliveira ACM de, Tavares MCM, Bezerra AR. Eating insecurity among pregnant women in the public health system in a state capital in the northeast of Brazil. Ciênc Saúde Coletiva. 2017;22(2):519–526.
  24. Park CY, Eicher–Miller HA. Iron Deficiency Is Associated with Food Insecurity in Pregnant Females in the United States:National Health and Nutrition Examination Survey 1999–2010. J Acad Nutr Diet. 2014;114(12):1967–1973.
  25. Santos FDS. “Elas têm fome de quê? (In) segurança alimentar e condições de saúde e nutrição de mulheres na fase gestacional”. 2015.
  26. Stevens B, Watt K, Brimbecombe J, et al. The role of seasonality on the diet and household food security of pregnant women living in rural Bangladesh: a cross–sectional study. Public Health Nutr. 2017;20(1):121–129.
  27. Tabares RQ, Astudillo MNM, Sierra LEÁ, et al. Estado nutricional y seguridad alimentaria en gestantes adolescentes. Pereira, Colombia, 2009. Investig Educ En Enferm. 2010;28(2):204–213.
  28. Zapata–López N, Restrepo–Mesa SL. Factors associated with maternal body mass index in a group of pregnant teenagers, Medellin, Colombia. Cad Saúde Pública. 2013;29(5):921–934.
  29. Whitaker RC, Phillips SM, Orzol SM. Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in their Preschool–Aged Children. Pediatrics. 2006;118(3):e859–868.
  30. Sraboni E, Malapit HJ, Quisumbing AR, et al. Women’s Empowerment in Agriculture: What Role for Food Security in Bangladesh? World Development. 2014;61:11–52.
  31. Garg A, Toy S, Tripodis Y, et al. Influence of maternal depression on household food insecurity for low–income families. Acad Pediatr. 2015;15(3):305–310.
  32. Fischer NC, Shamah–Levy T, Mundo–Rosas V, et al. Household Food Insecurity Is Associated with Anemia in Adult Mexican Women of Reproductive Age. J Nutr. 2014;144(12):2066–2072.
  33. Laraia B, Epel E, Siega–Riz AM. Food insecurity with past experience of restrained eating is a recipe for increased gestational weight gain. Appetite. 2013;65:178–184.
  34. Dharod JM, Croom JE, Sady CG. Food Insecurity: Its Relationship to Dietary Intake and Body Weight among Somali Refugee Women in the United States. J Nutr Educ Behav. 2013;45(1):47–53.
  35. Nanama S, Frongillo EA. Women’s rank modifies the relationship between household and women’s food insecurity in complex households in northern Burkina Faso. Food Policy. 2012;37(3):217–225.
  36. Martin MA, Lippert AM. Feeding her children, but risking her health: The intersection of gender, household food insecurity and obesity. Soc Sci Med Jun. 2012;74(11):1754–1764.
  37. Laraia BA, Borja JB, Bentley ME. Grandmothers, Fathers, and Depressive Symptoms Are Associated with Food Insecurity among Low–Income First–Time African–American Mothers in North Carolina. J Am Diet Assoc. 2009;109(6):1042–1047.
  38. Carmichael SL, Yang W, Herring A, et al. Maternal food insecurity is associated with increased risk of certain birth defects. J Nutr. 2007;137(9):2087–2092.
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