(P24-031-23) The Association Between Food Insecurity During Pregnancy and Gestational Diabetes Is Mitigated by Receipt of Food and Nutrition Assistance

Objectives: Food insecurity (FI) during pregnancy and gestational diabetes (GDM) are growing public health concerns. Nevertheless, FI, a critical social determinant of health, is understudied in relation to the risk of GDM, with limited and inconsistent findings. We examined the association between FI and GDM in a population-based sample of pregnant individuals.

Methods: We analyzed data from 17,484 pregnant individuals who received prenatal care at Kaiser Permanente Northern California and responded to an online survey between June 2020 and December 2021 about their experiences during the COVID-19 pandemic. FI during pregnancy was assessed using two screening questions validated against the US Department of Agriculture’s Core Food Security Module. GDM was ascertained from the electronic health records. We calculated adjusted odds ratio (aOR) and 95% CI of FI in association with GDM using logistic regression models adjusted for age at delivery, race and ethnicity, parity, pre-pregnancy BMI, and insurance type.

Results: FI during pregnancy was prevalent among 14.6% of participants and GDM among 8.4%. Individuals with FI compared to those without FI during pregnancy were more likely to be older at delivery (mean ± SD age in years: 33.2 ± 4.4 vs. 31.0 ± 5.3), Black (7.4% vs 2.9%) or Hispanic (34.6% vs. 17.7%), multiparous (56.7% vs. 50.8%), to have pre-pregnancy obesity (37.6% vs. 22.4%), Medicaid insurance (17.9% vs. 4.9%), and to receive food and nutrition assistance (25.3% vs. 4.8%), all P-values < 0.05. After adjusting for confounding factors, FI was associated with higher GDM odds (aOR: 1.20, CI: 1.03-1.40). Receipt of food and nutrition assistance modified the association (P-for-interaction < 0.001), where FI was more strongly associated with GDM odds among individuals who did not receive assistance (aOR: 1.27, CI: 1.08-1.50) but not associated with GDM odds among individuals who received assistance (aOR: 0.88, CI: 0.60-1.29).

Conclusions: FI during pregnancy was associated with GDM, specifically among individuals who did not receive food and nutrition assistance. Our findings suggest the importance of screening for FI during pregnancy and the need to support food and nutrition assistance programs.

Funding Sources: Supported by Kaiser Permanente Northern California Community Health grant and The Permanente Medical Group Delivery Science Fellowship Program.