Household Food Insecurity Is Associated with Self-Reported Pregravid Weight Status, Gestational Weight Gain, and Pregnancy Complications

Background: Household food insecurity is positively associated with weight among women. The association between household food insecurity and pregnancy-related weight gain and complications is not well understood. Objective: To identify whether an independent association exists between household food insecurity and pregnancy-related complications. Design: Data from the Pregnancy, Infection, and Nutrition prospective cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes ≤400% of the income/poverty ratio, recruited between January 2001 and June 2005 and followed through pregnancy. Main outcome measures: Self-reported pregravid body mass index, gestational weight gain, second trimester anemia, pregnancy-induced hypertension, and gestational diabetes mellitus. Statistical analyses performed: Multivariate linear, multinomial logistic, and logistic regression analyses. Results: Among 810 pregnant women, 76% were from fully food secure, 14% were from marginally food secure, and 10% were from food insecure households. In adjusted models, living in a food insecure household was significantly associated with severe pregravid obesity (adjusted odds ratio 2.97, 95% confidence intervals [CIs] 1.44 to 6.14), higher gestational weight gain (adjusted β coefficient 1.87, 95% CI 0.13 to 3.62), and with a higher adequacy of weight gain ratio (adjusted β .27, 95% CI 0.07 to 0.50). Marginal food security was significantly associated with gestational diabetes mellitus (adjusted odds ratio 2.76, 95% CI 1.00 to 7.66). Conclusions: This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain and pregnancy complications.