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Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

Published:August 31, 2021DOI:



      Low food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.


      This study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.


      This was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.

      Participants and setting

      This study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.

      Main outcome measure

      Diet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.

      Statistical analysis performed

      Multiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.


      In this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03).


      Very low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.


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      S. Gonzalez-Nahm is an assistant professor, Department of Nutrition, University of Massachusetts Amherst, Amherst, MA.


      T. Østbye is a professor, Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC.


      C. Hoyo is a professor, Department of Biological Sciences, North Carolina State University, Raleigh, NC.


      R. Kravitz is a professor, Department of Pediatrics, Duke University Medical Center, Durham, NC.


      S. Benjamin-Neelon is a professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.