Highlights
- •Community-level food insecurity increased the risk of not achieving glycemic control in early pregnancy.
- •Food insecurity impacts glycemic control among pregnant individuals with diabetes.
- •Interventions targeting food insecurity to improve glycemic control and perinatal outcomes are needed.
Abstract
Aim
To evaluate whether pregnant individuals with pregestational diabetes who live in
a food-insecure community have worse glycemic control compared to those who do not
live in a food-insecure community.
Methods
A retrospective analysis of pregnant individuals with pregestational diabetes enrolled
in a multidisciplinary prenatal and diabetes care program. The exposure was community-level
food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and
an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy.
Results
Among 418 assessed pregnant individuals with pregestational diabetes, those living
in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy
compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted
risk ratio (aRR): 0.55; 95 % CI: 0.33–0.92]. Individuals living in a food-insecure
community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR:
1.55; 95 % CI: 1.06–2.28] and a larger mean decrease in A1c across pregnancy [mean:
1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06–0.87)].
Conclusions
Pregnant individuals with pregestational diabetes who lived in a food-insecure community
were less likely to enter pregnancy with glycemic control, but were more likely to
have a reduction in A1c and achieve similar A1c status compared to those who lived
in a community without food insecurity. Whether interventions that address food insecurity
improve glycemic control and consequent perinatal outcomes remains to be studied.
Keywords
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Article info
Publication history
Published online: November 12, 2022
Accepted:
November 4,
2022
Received in revised form:
October 19,
2022
Received:
October 5,
2022
Identification
Copyright
© 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
