(664) Empty Plates, Smaller Weights: Exploring the Association Between Food Insecurity and Fetal Growth Restriction

Fetal growth restriction (FGR) is a marker of placental insufficiency and adverse perinatal outcomes. The relationship between neighborhood-level food insecurity and FGR remains underexplored. We examined whether residence in USDA-defined areas of food insecurity is associated with FGR to understand the impact of unmet nutritional needs on fetal growth.


Study Design:

We conducted a retrospective cohort study of singleton pregnancies receiving prenatal care and delivering ≥24 weeks at Henry Ford Health System (2015–2023). Residential addresses were geocoded and linked to USDA Food Access Research Atlas data of food insecurity, defined by low income (LI), low access (LA), and low vehicle access. FGR was defined as estimated fetal weight (EFW) or abdominal circumference < 10th percentile by ultrasound. Multivariable logistic regression assessed associations between residence in areas of food insecurity and FGR, adjusting for maternal age, and urban status. Analyses were performed using R 4.4.0 with α=0.05.


Results:

Among 38,597 pregnancies, 3,074 (8.0%) were diagnosed with FGR. Univariate analysis showed those with FGR were younger (27.9 vs 29.1 years, p< 0.001) and resided in LI tracts (63.8% vs 56.1%, p< 0.001) and areas with low vehicle access (27.6% vs 24.6%, p< 0.001). In multivariable analysis, FGR was associated with urban residence (aOR 1.48, 95% CI: 1.13–1.94), LI tract residence (aOR 1.20, 95% CI: 1.10–1.32), and younger age (aOR 0.97, 95% CI: 0.965–0.976). LA alone was no longer significant (p=0.051).


Conclusion:
Residence in areas of food insecurity, particularly those with low income or urban designation, is significantly associated with FGR. Notably, low access alone was not a significant predictor. These findings suggest that financial hardship and urban structural inequities may be more impactful than proximity to food alone. Targeted interventions must address the economic and systemic barriers contributing to fetal growth disparities.