Food Insecurity and Cardiovascular Health in Pregnant Women: Results From the Food for Families Program, Chelsea, Massachusetts, 2013–2015

Abstract

BackgroundFood insecurity, uncertainty about the ability to acquire adequate food, is associated with cardiometabolic disease in pregnant women. Whether food insecurity interventions improve cardiometabolic health is unknown.MethodsWe conducted a retrospective analysis of women who visited the obstetrics clinic in a community health center from 2013 through 2015. Patients could be referred to the Food for Families (Food for Families) program, which connects food insecure women to food resources. We hypothesized that participation in Food for Families would be associated with better blood pressure and blood glucose trends during pregnancy. We used a propensity score–matched design to reduce bias from differential entry into Food for Families.ResultsEleven percent of women who visited the obstetrics clinic were referred to Food for Families. In propensity score–matched analyses, we found no difference in baseline systolic blood pressure (SBP) between those who were referred and enrolled in Food for Families (113.5 mm Hg), those who were referred and did not enroll in Food for Families (113.9 mm Hg), and those who were not referred to Food for Families (114 mm Hg) (P = .79). However, during pregnancy, women who were referred to and enrolled in Food for Families had a better SBP trend (0.2015 mm Hg/wk lower, P = .006). SBP trends did not differ between women who were referred and did not enroll in Food for Families and those who were not referred. We observed no differences in blood glucose trends between groups (P = .40).ConclusionsFood for Families participation was associated with better blood pressure trends in pregnant women but no differences in blood glucose trends. Food insecurity reduction programs may improve cardiovascular health for vulnerable pregnant women, and this topic deserves further study incorporating randomized program entry.

Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review

“…There were 2 randomized control trials (RCT) (9%), 16,21 1 cluster RCT (4%), 22 2 quasi-experimental studies (9%), 17,18 3 matched cohort studies (13%), [23][24][25] and 8 single group, pre-/post-studies (35%). [26][27][28][29][30][31][32][33] The remainder of the studies had descriptive, mixed methods, or qualitative designs (n = 7, 30%).…”

“…[26][27][28][29][30][31][32][33] The remainder of the studies had descriptive, mixed methods, or qualitative designs (n = 7, 30%). Some articles focused on specific patient populations: 9 studies evaluated interventions targeting adult caregivers of pediatric patients (39%), 16,21,22,28,29,31,[34][35][36] 1 targeted adolescents (4%), 37 2 focused on pregnant women (9%), 18,24 5 focused on patients with diabetes 27,30,32,33,39 or another chronic condition 25 (22%), and 1 focused on patients with cancer (4%). 38 Seventeen studies (74%) were considered low 17,26,28,30,31,32,37 or very low quality 18,27,29,[33][34][35][36][38][39][40] and 6 (26%) studies were rated moderate quality.…”

“…38 Seventeen studies (74%) were considered low 17,26,28,30,31,32,37 or very low quality 18,27,29,[33][34][35][36][38][39][40] and 6 (26%) studies were rated moderate quality. 16,[21][22][23][24][25] Interventions fell into 2 categories based on the food-related resources or assistance pro-vided. One group included 12 studies (52%) that described education and/or referral interventions.…”

“…These provided information for patients about food resources 16,22,27,30,35,40 or more actively connected them to referral services through a navigator or other lay staff person. 21,24,28,29,34,37 We combined passive (resource information provided) and active (assistance contacting resource) referral interventions into 1 category as results were too heterogenous to make meaningful comparisons between the 2 referral types. A second group included 10 studies (43%) examining interventions that provided food or food vouchers in addition to resource referrals 17,18,25,26,[31][32][33]36,38,39 and 1 study that provided food without referrals to community food resources.…”

“…One referral program in pregnant women attending an obstetrics clinic found a small improvement in blood pressure control during pregnancy. 24 A separate prenatal nutrition intervention included general nutritional information, cooking classes, and distribution of vouchers for fruits/vegetables at a local farmers market. 18 The evaluation showed no significant effect on infant or maternal outcomes 18 (Table 3).…”