Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
Am J Clin Nutr. 2024 May;119(5):1216-1226. doi: 10.1016/j.ajcnut.2024.02.022. Epub 2024 Mar 1.
Limited access to healthy foods, resulting from residence in neighborhoods with low-food access or from household food insecurity, is a public health concern. Contributions of these measures during pregnancy to birth outcomes remain understudied.
We examined associations between neighborhood food access and individual food insecurity during pregnancy with birth outcomes.
We used data from 53 cohorts participating in the nationwide Environmental Influences on Child Health Outcomes-Wide Cohort Study. Participant inclusion required a geocoded residential address or response to a food insecurity question during pregnancy and information on birth outcomes. Exposures include low-income-low-food-access (LILA, where the nearest supermarket is >0.5 miles for urban or >10 miles for rural areas) or low-income-low-vehicle-access (LILV, where few households have a vehicle and >0.5 miles from the nearest supermarket) neighborhoods and individual food insecurity. Mixed-effects models estimated associations with birth outcomes, adjusting for socioeconomic and pregnancy characteristics.
Among 22,206 pregnant participants (mean age 30.4 y) with neighborhood food access data, 24.1% resided in LILA neighborhoods and 13.6% in LILV neighborhoods. Of 1630 pregnant participants with individual-level food insecurity data (mean age 29.7 y), 8.0% experienced food insecurity. Residence in LILA (compared with non-LILA) neighborhoods was associated with lower birth weight [β -44.3 g; 95% confidence interval (CI): -62.9, -25.6], lower birth weight-for-gestational-age z-score (-0.09 SD units; -0.12, -0.05), higher odds of small-for-gestational-age [odds ratio (OR) 1.15; 95% CI: 1.00, 1.33], and lower odds of large-for-gestational-age (0.85; 95% CI: 0.77, 0.94). Similar findings were observed for residence in LILV neighborhoods. No associations of individual food insecurity with birth outcomes were observed.
Residence in LILA or LILV neighborhoods during pregnancy is associated with adverse birth outcomes. These findings highlight the need for future studies examining whether investing in neighborhood resources to improve food access during pregnancy would promote equitable birth outcomes.
由于居住在食物获取途径较少的社区或家庭食物不安全，导致获取健康食品的机会有限，这是一个公共卫生关注点。在怀孕期间，这些措施对出生结果的贡献仍研究不足。
我们研究了怀孕期间社区食物获取和个体食物不安全与出生结果之间的关联。
我们使用了来自全国范围内环境对儿童健康结果影响的广泛队列研究中的 53 个队列的数据。参与者纳入标准要求在怀孕期间有一个地理编码的居住地址或对食物不安全问题的回答，以及有关出生结果的信息。暴露包括低收入低食物获取（LILA，城市地区最近的超市距离超过 0.5 英里，农村地区超过 10 英里）或低收入低车辆获取（LILV，很少有家庭拥有车辆，距离最近的超市超过 0.5 英里）社区和个体食物不安全。混合效应模型估计了与出生结果的关联，同时调整了社会经济和妊娠特征。
在 22206 名有社区食物获取数据的孕妇（平均年龄 30.4 岁）中，24.1%的孕妇居住在 LILA 社区，13.6%的孕妇居住在 LILV 社区。在 1630 名有个体层面食物不安全数据的孕妇（平均年龄 29.7 岁）中，8.0%的孕妇经历了食物不安全。与非 LILA 社区相比，居住在 LILA 社区与较低的出生体重[β-44.3 g；95%置信区间（CI）：-62.9，-25.6]、较低的出生体重与胎龄 z 评分（-0.09 标准差单位；-0.12，-0.05）、较高的小于胎龄儿发生风险[比值比（OR）1.15；95%CI：1.00，1.33]和较低的大于胎龄儿发生风险（0.85；95%CI：0.77，0.94）相关。居住在 LILV 社区也有类似的发现。个体食物不安全与出生结果之间没有关联。
在怀孕期间居住在 LILA 或 LILV 社区与不良的出生结果有关。这些发现强调了未来研究需要检验的问题，即投资于改善怀孕期间社区资源以促进食物获取是否会促进公平的出生结果。
