The association between food desert severity, socioeconomic status, and metabolic state during pregnancy in a prospective longitudinal cohort

Abstract

Poor metabolic health during pregnancy is associated with health concerns for pregnant individuals and their offspring. Lower socioeconomic status (SES) is one risk factor for poor metabolic health, and may be related to limited access to healthful and affordable foods (e.g., living in a food desert). This study evaluates the respective contributions of SES and food desert severity on metabolic health during pregnancy. The food desert severity of 302 pregnant individuals was determined using the United States Department of Agriculture Food Access Research Atlas. SES was measured using total household income adjusted for household size, years of education, and amount of reserve savings. Information about participants’ glucose concentrations one hour following an oral glucose tolerance test during the second trimester was extracted from medical records and percent adiposity during the second trimester was assessed using air displacement plethysmography. Information about participants’ nutritional intake during the second trimester was obtained by trained nutritionists via three unannounced 24-h dietary recalls. Structural equation models showed that lower SES predicted higher food desert severity (β = − 0.20, p = 0.008) and higher adiposity (β = − 0.27, p = 0.016) and consumption of a more pro-inflammatory diet (β = − 0.25, p = 0.003) during the second trimester of pregnancy. Higher food desert severity also predicted higher percent adiposity during the second trimester (β = 0.17, p = 0.013). Food desert severity significantly mediated the relationship between lower SES and higher percent adiposity during the second trimester (βindirect = − 0.03, 95% CI [− 0.079, − 0.004]). These findings indicate that access to healthful and affordable foods is a mechanism by which SES contributes to adiposity during pregnancy and may inform interventions intended to improve metabolic health during pregnancy.

Association of Food Desert Residency and Preterm Birth in the United States

“…Within our fully adjusted analysis, we determined that residing in a USDA-designated food desert increased the likelihood of preterm birth in a dose-response manner. Our results were consistent with existing studies that linked inadequate access to healthy foods to poor maternal health and birth outcomes [9,31,32]. Furthermore, residing in a food desert has been associated with health implications beyond conception health and birthing outcomes.…”

Association between density of food retailers and fitness centers and gestational diabetes mellitus in Eastern Massachusetts, USA: population-based study

“…2 ). However, other studies have reported that a lack of access to healthy foods can mediate the relationship between lower SES and higher body fat during pregnancy, 37 and that lower neighborhood-level SES was associated with reduced vegetable consumption. 38 Thus, research in other settings is warranted to determine if SES disparities exist in the relationship between the food environment the odds of having GDM among pregnant individuals.…”

Food Choice and Dietary Perspectives of Young, Urban, Black Pregnant Women: A Focus Group Study

“…To our knowledge, only a few studies discuss food choice and linkages to food apartheid, food deserts, or food inequities and their impact on pregnant Black women [8,23,[34][35][36]. These studies reported that built food environments are significantly associated with pregnancy morbidity [34,36] and impede food choice [35]. Specifically for Black women, Reyes et al (2013) examined motivators and barriers to healthy eating in 21 overweight Black pregnant women in Philadelphia [8].…”

“…To our knowledge, only a few studies discuss food choice and linkages to food apartheid, food deserts, or food inequities and their impact on pregnant Black women [ 8 , 23 , 34 , 35 , 36 ]. These studies reported that built food environments are significantly associated with pregnancy morbidity [ 34 , 36 ] and impede food choice [ 35 ].…”