Pasha Veronica C, Gerchow Lauren, Lyndon Audrey, Clark-Cutaia Maya, Wright Fay
Department of Nursing, New York University Rory Meyers College of Nursing, New York, New York, USA.
Health Equity. 2024 Mar 21;8(1):206-225. doi: 10.1089/heq.2023.0116. eCollection 2024.
Food insecurity is a major public health concern in the United States, particularly for pregnant and postpartum individuals. In 2020, ∼13.8 million (10.5%) U.S. households experienced food insecurity. However, the association between food security and pregnancy outcomes in the United States is poorly understood.
The purpose of this review was to critically appraise the state of the evidence related to food insecurity as a determinant of health within the context of pregnancy in the United States. We also explored the relationship between food insecurity and pregnancy outcomes.
PubMed, CINAHL, Web of Science, and Food and Nutrition Science databases were used. The inclusion criteria were peer-reviewed studies about food (in)security, position articles from professional organizations, and policy articles about pregnancy outcomes and breastfeeding practices. Studies conducted outside of the United States and those without an adequate definition of food (in)security were excluded. Neonatal health outcomes were also excluded. Included articles were critically appraised with the STROBE and Critical Appraisal Skills Program checklists.
Nineteen studies met the inclusion criteria. Inconsistencies exist in defining and measuring household food (in)security. Pregnant and postpartum people experienced several adverse physiological and psychological outcomes that impact pregnancy compared with those who do not. Intersections between neighborhood conditions and other economic hardships were identified. Findings regarding the impact of food insecurity on breastfeeding behaviors were mixed, but generally food insecurity was not associated with poor breastfeeding outcomes in adjusted models.
Inconsistencies in definitions and measures of food security limit definitive conclusions. There is a need for standardizing definitions and measures of food insecurity, as well as a heightened awareness and policy change to alleviate experiences of food insecurity.
粮食不安全是美国主要的公共卫生问题，对孕妇和产后人群尤为如此。2020年，约1380万（10.5%）美国家庭面临粮食不安全问题。然而，美国粮食安全与妊娠结局之间的关联尚不清楚。
本综述的目的是严格评估在美国妊娠背景下，作为健康决定因素的粮食不安全相关证据的状况。我们还探讨了粮食不安全与妊娠结局之间的关系。
使用了PubMed、CINAHL、科学网和食品与营养科学数据库。纳入标准为关于粮食（不）安全的同行评议研究、专业组织的立场文章以及关于妊娠结局和母乳喂养实践的政策文章。排除在美国境外进行的研究以及那些对粮食（不）安全没有充分定义的研究。新生儿健康结局也被排除。纳入的文章使用STROBE和批判性评估技能计划清单进行严格评估。
19项研究符合纳入标准。在家庭粮食（不）安全的定义和衡量方面存在不一致。与未经历粮食不安全的孕妇和产后人群相比，经历粮食不安全的孕妇和产后人群出现了几种影响妊娠的不良生理和心理结局。确定了社区条件与其他经济困难之间的交叉点。关于粮食不安全对母乳喂养行为影响的研究结果不一，但在调整模型中，粮食不安全通常与不良母乳喂养结局无关。
粮食安全定义和衡量方法的不一致限制了确定性结论。需要对粮食不安全的定义和衡量方法进行标准化，同时提高认识并改变政策，以缓解粮食不安全状况。
