(233) Food Insecurity, Systemic and Placental Inflammation, and Adverse Perinatal Outcomes

Food insecurity during pregnancy has been consistently linked to adverse birth outcomes, potentially due to increased inflammation. This study compared systemic and placental inflammation among pregnant patients experiencing food insecurity and those who were food secure to investigate inflammation patterns associated with food insecurity in pregnancy.

Study Design:

605 participants were enrolled in the prospective Stress, Pregnancy, and Health (SPAH) study 2018-2022. Food insecurity was assessed during the 3^rd trimester using the validated 2-Item Hunger Vital Sign screener. Serum cytokines were measured via 2^nd trimester blood draw and placentas were collected at delivery, with biopsies reviewed for inflammatory and vascular lesions. Multivariable analyses were adjusted for maternal age, gestational age at sample collection, and race/ethnicity.

Results:

Among 524 participants, 57 (10.9%) screened positive for food insecurity. Food-insecure participants were more likely to be enrolled in Medicaid, have lower household education, higher household unemployment, and higher BMI (all p < 0.05).  Participants with food insecurity were more likely to experience adverse neonatal outcomes (aOR = 3.00, p=0.004), including preterm birth (aOR=2.36, p=0.044) and neonatal intensive care admission (aOR=3.48, p=0.006). However, no significant associations were found between food insecurity and elevated pro-inflammatory cytokines or placental inflammatory and vascular pathology (all p >0.2).

Conclusion:

Food insecurity during pregnancy is a significant risk factor for adverse perinatal outcomes. However, this risk does not appear to operate through systemic inflammation or placental pathology. Addressing food insecurity in pregnancy is an opportunity to reduce perinatal risk. Other biological or psychosocial mechanisms may drive the relationship between food insecurity and poor birth outcomes, warranting further investigation.