(P18-025-23) Trends in Food Insecurity in Pregnancy, the Pregnancy Risk Assessment Monitoring System, 2004-2020

Objectives: Food insecurity (FI) in pregnancy may put pregnant people at an increased risk for adverse outcomes. We estimate population-based trends and risk factors of FI.

Methods: We analyzed data from 125140 pregnant people ≥18 years of age, who delivered infants between 2004 and 2020 within 14 states participating in the Pregnancy Risk Assessment Monitoring System. Participants were asked, “During the 12 months before your new baby was born, did you ever eat less than you felt you should because there wasn’t enough money to buy food?” which is likely reflective of more severe FI due to the presence of disrupted eating. We estimated age and state adjusted FI prevalence estimates using the direct method with data weighted to the 2020 distributions. We examined risk factors of FI using multivariable logistic regression adjusting for age, race/ethnicity, marital status, parity, number of people dependent on income, insurance type, education, and state. In all analyses, data were weighted to account for the complex sampling design and nonresponse rates and to reflect population estimates.

Results: FI prevalence was 8.8% (95% confidence interval 8.5, 9.0) and it varied across years (P < 0.0001). The adjusted prevalence in 2004 and 2020 was 8.6% (7.3, 9.8) and 6.4% (5.7, 7.1), respectively – 2020 is likely reflective of pre-pandemic levels based on the timing of the question. The prevalence fluctuated by 1-2% between years and was highest in 2013 at 9.9% (8.0, 11.1). Compared to non-Hispanic white individuals, American Indian/Alaskan Native (OR=1.28; 1.10, 1.50) and ‘other’ or ‘mixed race/ethnicity’ individuals (OR=1.18; 1.01, 1.39) were more likely to experience FI, while Hispanic (OR=0.87; 0.79, 0.96) and Asian/Pacific Islander (OR=0.60; 0.49, 0.72) individuals were less likely to experience FI. Compared to nulliparous individuals, those with 2 (OR=1.50; 1.30, 1.72), 3-5 (OR=1.71; 1.45, 2.01), and ≥ 6 (OR=2.89; 2.09, 4.01) children were more likely to experience FI. Compared to married individuals, non-married (OR=2.34; 2.15, 2.55) individuals were more likely experience FI. Younger and less educated individuals were also more likely to experience FI.

Conclusions: Within this dataset, modest improvements in the prevalence of severe FI among pregnant people were observed prior to 2020, yet substantial disparities remain.

Funding Sources: This research is supported in part by NIH.