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Oresnik S, Moffat T, McKerracher L, Sloboda DM. A syndemic perspective on food insecurity, gestational diabetes, and mental health disorders during pregnancy. Soc Sci Med 2025; 373:117994. [PMID: 40158449 DOI: 10.1016/j.socscimed.2025.117994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 03/12/2025] [Accepted: 03/17/2025] [Indexed: 04/02/2025]
Abstract
Pregnancy brings numerous physiological and psychosocial changes and conditions that may include gestational diabetes mellitus (GDM) and anxiety and mood disorders. Household food insecurity (HFI)-not having access to food that meets dietary needs and preferences-may put pregnant people at risk for developing pregnancy complications like GDM. This study used qualitative and quantitative methods to understand, from a syndemic perspective, the intersections among these conditions in Canada. Using the Canadian Community Health Survey cycles from 2009 to 2018, we fit multivariable and multivariate logistic regressions to these data to understand interactions among food insecurity, anxiety and mood disorders, and GDM. We also conducted four focus group discussions (FGDs) and six one-on-one interviews with pregnant and postpartum people living in Hamilton, Ontario. Analyses of the survey data show that pregnant individuals who reported an anxiety and/or mood disorder were more likely to experience HFI. Those who experienced HFI were also more likely to be diagnosed with GDM during pregnancy or report an anxiety and/or mood disorder. Major themes identified from interviews and FGDs revealed that structural variables impact access to food, that a GDM diagnosis increased anxiety, and that experiencing HFI exacerbates the management of these conditions during pregnancy. The potential interactions among HFI, GDM, and anxiety and/or mood disorders indicate that addressing rising HFI alongside prevention and treatment of GDM and anxiety and mood disorders are critical to improving the health and well-being of pregnant people in Canada.
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Affiliation(s)
- Sarah Oresnik
- McMaster University, Department of Anthropology, 524 Chester New Hall, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada.
| | - Tina Moffat
- McMaster University, Department of Anthropology, 524 Chester New Hall, 1280 Main Street West, Hamilton, Ontario, L8S 4M4, Canada
| | - Luseadra McKerracher
- Aarhus University, Department of Public Health, Department of Health Services Research, Bartholins Allé 2, Aarhus C, 8000, Denmark
| | - Deborah M Sloboda
- McMaster University, Department of Biochemistry and Biomedical Sciences, McMaster Children's Hospital, HSC - 4N59, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
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Lim EJK, Ong C, Said Abdul Rashid NS, Lee JJM, Chew J, Chua MC. Food Accessibility and Nutritional Outcomes Among Food-Insecure Pregnant Women in Singapore. Nutrients 2025; 17:835. [PMID: 40077705 PMCID: PMC11902187 DOI: 10.3390/nu17050835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Revised: 02/19/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
Background/Objectives: Food insecurity during pregnancy is associated with higher risks of negative physical outcomes for both mother and child. This study aims to understand experiences of food insecurity among low-income Singaporean pregnant women and its impact on nutritional status. Methods: In this cross-sectional, mixed-methods study, 49 food-insecure pregnant women were recruited from KK Women's and Children's Hospital between November 2021 and November 2023, among which 11 in-depth interviews were conducted. Questionnaires, anthropometric measurements, 24-Hour dietary recalls, metabolic and nutritional blood tests were conducted for all subjects. Descriptive quantitative analysis was performed and integrated with qualitative thematic analysis to explain findings. Results: On average, women were overweight pre-pregnancy (body mass index 26.1 ± 6.9 kg/m2) and had low haemoglobin and 25-hydroxyvitamin D levels. Calorie intake and intake from major food groups did not meet recommendations during pregnancy, except for "Grains". From interviews, effects of financial constraints, how participants managed their food supply and pregnancy-related symptoms, supported findings from 24-Hour dietary recalls. Conclusions: Food insecurity led to suboptimal nutritional status and diets in Singaporean pregnant women despite appearing well-nourished. Further exploration of perspectives of food-insecure mothers, healthcare providers and welfare organisations is needed to devise long-term solutions to improve food security and alleviate malnutrition.
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Affiliation(s)
- Ethel Jie Kai Lim
- Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore 229899, Singapore; (C.O.); (N.S.S.A.R.)
| | - Chengsi Ong
- Department of Nutrition and Dietetics, KK Women’s and Children’s Hospital, Singapore 229899, Singapore; (C.O.); (N.S.S.A.R.)
- SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | | | - Jeannette Jen-Mai Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore;
| | - Judith Chew
- Department of Medical Social Work, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
| | - Mei Chien Chua
- SingHealth Duke-NUS Maternal and Child Health Research Institute, KK Women’s and Children’s Hospital, Singapore 229899, Singapore;
- Department of Neonatology, KK Women’s and Children’s Hospital, Singapore 229899, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Vilme H, Zhang FF, O’Tierney-Ginn P, Sun CH, Anyanwu OA, Fahmi R, Folta SC. Gaining stakeholder perspectives to shape a produce prescription program to improve maternal and birth outcomes: a qualitative study. Front Public Health 2025; 12:1462908. [PMID: 39882113 PMCID: PMC11774915 DOI: 10.3389/fpubh.2024.1462908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 12/30/2024] [Indexed: 01/31/2025] Open
Abstract
Introduction Nutrition during pregnancy significantly impacts maternal and birth outcomes. A key factor contributing to the rise in adverse maternal and birth outcomes is poor nutrition. Produce prescription programs have the potential to address pregnancy-related adverse outcomes such as hypertensive disorders and gestational diabetes, but scientific evidence is limited. Purpose To conduct qualitative interviews to gain an in-depth understanding of how, why, and in what context should produce prescriptions be implemented to best meet the needs of pregnant women in a clinical setting. Methods We conducted interviews with 11 patients with low incomes and/or experiencing food insecurity and 11 clinic staff from a major metropolitan OB/GYN clinic. Interview questions were designed to understand attitudes toward participating in or helping implement a produce prescription program. We analyzed the data using a deductive qualitative content analysis approach. Results Both patients and clinic staff perceived many benefits to this type of program, including easing financial strain, removing barriers to access, and addressing nutrition security during pregnancy. Both groups described a need to consider participants' autonomy in the program design. Patients also perceived some drawbacks to the home delivery aspect, such as limited participation by patients due to unstable housing. Staff expressed some concerns about the staff time needed to implement this type of program. Conclusion There was strong support for produce prescription programs for this population; however, results indicate that they may best meet needs if patient autonomy and delivery-related barriers are considered in the design. Designating screening and enrollment tasks for ancillary staff may facilitate implementation in clinics.
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Affiliation(s)
- Helene Vilme
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Perrie O’Tierney-Ginn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
- School of Medicine, Tufts University, Boston, MA, United States
| | - Chenchen H. Sun
- School of Medicine, Tufts University, Boston, MA, United States
| | - Oyedolapo A. Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Rukhshan Fahmi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Bagheri M, Lamyian M, Sadighi J, Ahmadi F, Mohammadi-Nasrabadi F. Food security during pregnancy: A qualitative content analysis study in Iran. MATERNAL & CHILD NUTRITION 2025; 21:e13725. [PMID: 39311043 DOI: 10.1111/mcn.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/23/2024] [Accepted: 08/20/2024] [Indexed: 12/18/2024]
Abstract
Food security during pregnancy is crucial for safeguarding the health of expectant mothers and optimizing prenatal outcomes. Food insecurity can manifest in varying degrees, ranging from moderate disruptions to the quality and diversity of diet to severe cases that disrupt dietary patterns and reduce overall food intake. Limited information exists regarding food security among pregnant women in Iran. Therefore, this qualitative study aims to investigate food security during pregnancy from the perspectives of pregnant women (n = 17) and experts in food security (n = 6). Data were collected through purposeful sampling and 23 semi-structured interviews. The data analysis process occurred concurrently with data collection, employing a conventional content analysis approach. The findings underwent rigorous evaluation based on credibility, confirmability, dependability, transferability and authenticity. The results revealed that access to quality foods in pregnancy depends on the sustainability of food resources, economic access to food, the family's food budget, pregnant women's utilization of food due to pregnancy conditions, their nutritional literacy and cultural practices. Pregnant women employ various strategies to cope with food insecurity and require social and governmental support to manage it effectively. Therefore, it is suggested that health care authorities initially assess the level of food security among pregnant women and subsequently, through equitable food distribution, reform culture and increase food literacy, providing practical and informative educational programmes, and structured support, improve their food security.
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Affiliation(s)
- Maryam Bagheri
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Minoor Lamyian
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Jila Sadighi
- Health Metrics Research Center, ACECR, Iranian Institute for Health Sciences Research, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Food and Nutrition Policy and Planning Research Department, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Muluve E, Karp C, Osuka D, Nanjekho R, Mwanga D, Moreau C, Austrian K. Experiences of Pregnant and Parenting Adolescents and Young Women During COVID-19 Pandemic: A Mixed-Methods Study Among Girls and Women in Kenya. J Adolesc Health 2024; 75:S35-S42. [PMID: 39567057 DOI: 10.1016/j.jadohealth.2024.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 08/27/2024] [Accepted: 09/12/2024] [Indexed: 11/22/2024]
Abstract
PURPOSE This study examines the experiences of pregnant/parenting adolescents and young women during the first two years of the coronavirus disease 2019 (COVID-19) pandemic. METHODS This explanatory sequential mixed-methods study leverages quantitative data collected among a cohort of adolescents and young people aged 15-22 years in three Kenyan counties; Nairobi, Kisumu, and Kilifi at three time points (2020, 2021, 2022), and two rounds of qualitative interviews in the same settings conducted in 2020 and 2022. RESULTS Among 2337 (2020), 1438 (2021), and 1669 (2022) respondents, pregnant/parenting adolescents and youth comprised 140 (6%), 101 (7%), and 83 (5%) individuals, respectively. Across the three time points, the experience of depressive symptoms was similar between pregnant/parenting adolescents and those not pregnant/parenting. Pregnancy and parenting was associated with twice the odds of skipping health services (adjusted odds ratio [aOR] 2.18, 95% confidence interval [CI] 1.43-3.35), in 2020, and 85% higher odds (aOR 1.85, 95% CI 1.14-3.02) in 2021, and 90% higher odds of skipping meals (aOR 1.90, 95% CI 1.19-3.03) in 2022. Qualitative findings indicated experiences of psychological distress, food insecurity, and inadequate access to health care services among pregnant/parenting young people during the pandemic. DISCUSSION The pandemic increased pre-existing challenges associated with adolescent and young people's health, predisposing young pregnant/parenting women to greater adversity than their nonpregnant/parenting counterparts. Targeted and responsive approaches during emergencies and crises such as social protection, food security, and mental health programs for this group of vulnerable people are required and need to be integrated into disaster response plans.
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Affiliation(s)
| | - Celia Karp
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Daniel Mwanga
- Data Science and Evaluations, African Population and Health Research Center, Nairobi, Kenya; Department of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Douglas F. What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us. Proc Nutr Soc 2024; 83:170-179. [PMID: 37799071 DOI: 10.1017/s0029665123003713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.
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Affiliation(s)
- Flora Douglas
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
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Willford JA, Kaufman JM. Through a teratological lens: A narrative review of exposure to stress and drugs of abuse during pregnancy on neurodevelopment. Neurotoxicol Teratol 2024; 105:107384. [PMID: 39187031 DOI: 10.1016/j.ntt.2024.107384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Teratological research shows that both prenatal stress and prenatal substance exposure have a significant impact on neurodevelopmental outcomes in children. Using human research, the purpose of this narrative review is to explore the degree to which these exposures may represent complex prenatal and postnatal risks for the development of cognition and behavior in children. An understanding of the HPA axis and its function during pregnancy as well as the types and operationalization of prenatal stress provide a context for understanding the direct and indirect mechanisms by which prenatal stress affects brain and behavior development. In turn, prenatal substance exposure studies are evaluated for their importance in understanding variables that indicate a potential interaction with prenatal stress including reactivity to novelty, arousal, and stress reactivity during early childhood. The similarities and differences between prenatal stress exposure and prenatal substance exposure on neurodevelopmental outcomes including arousal and emotion regulation, cognition, behavior, stress reactivity, and risk for psychopathology are summarized. Further considerations for teratological studies of prenatal stress and/or substance exposure include identifying and addressing methodological challenges, embracing the complexity of pre-and postnatal environments in the research, and the importance of incorporating parenting and resilience into future studies.
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Affiliation(s)
- Jennifer A Willford
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America.
| | - Jesse M Kaufman
- Slippery Rock University, Department of Psychology, 1 Morrow Way, Slippery Rock, PA 16057, United States of America
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Whiteoak B, Dawson SL, Callaway L, de Jersey S, Eley V, Evans J, Kothari A, Navarro S, Gallegos D. Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study. Nutrients 2024; 16:1319. [PMID: 38732568 PMCID: PMC11085356 DOI: 10.3390/nu16091319] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.
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Affiliation(s)
- Bree Whiteoak
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
| | - Samantha L. Dawson
- Food & Mood Centre, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC 3220, Australia;
| | - Leonie Callaway
- Women’s and Newborns Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Susan de Jersey
- Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia;
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia
| | - Victoria Eley
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4006, Australia
| | - Joanna Evans
- Maternity Services, Caboolture Hospital, McKean Street, Caboolture, QLD 4510, Australia;
| | - Alka Kothari
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
- Redcliffe Hospital, Anzac Avenue, Redcliffe, QLD 4020, Australia
| | - Severine Navarro
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
- QIMR Berghofer Medical Research Institute, 300 Herston Rd., Herston, QLD 4006, Australia
- Faculty of Medicine, The University of Queensland, 288 Herston Rd., Herston, QLD 4006, Australia; (V.E.); (A.K.)
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD 4059, Australia;
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD 4101, Australia;
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Saxe-Custack A, LaChance J, Kerver JM. A Fresh Fruit and Vegetable Prescription Program for Prenatal Patients in Flint, Michigan: Baseline Food Security and Dietary Intake. Nutrients 2024; 16:1234. [PMID: 38674924 PMCID: PMC11054465 DOI: 10.3390/nu16081234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Although adequate nutritional status during pregnancy is necessary to support optimal fetal development, many low-income women have poor access to fresh, high-nutrient foods. To address these challenges, a pediatric fruit and vegetable (FV) prescription program was expanded to include pregnant women, providing one prescription for fresh FVs worth 15 US dollars during each prenatal office visit for redemption at farmers'/mobile markets. This analysis describes baseline sociodemographic characteristics, food security, and dietary intake among 253 pregnant women in Flint, Michigan in 2022-23. Dietary recall data were collected and analyzed using the Automated Self-Administered 24-h Tool developed by the US National Cancer Institute, with nutrition output reported in relation to adherence to US Dietary Guidelines. Most participants (mean ± SD age 26.51 ± 4.90 years) identified as African American (53%) and were receiving publicly funded health insurance (66%). Most (75%) reported no food insecurity, yet the majority failed to meet dietary recommendations for whole grains (99.3%), vegetables (93.1%), dairy (93.1%), and fruits (69.4%). Moreover, most did not meet micronutrient recommendations through food sources, including vitamin D (100%), iron (98.6%), folic acid (98.6%), vitamin A (82.6%), calcium (68.8%), and vitamin C (62.5%). Results raise deep concerns regarding diet and nutrition among pregnant women in this US city.
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Affiliation(s)
- Amy Saxe-Custack
- Charles Stewart Mott Department of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA;
| | - Jenny LaChance
- Charles Stewart Mott Department of Public Health, Michigan State University-Hurley Children’s Hospital Pediatric Public Health Initiative, Flint, MI 48502, USA;
| | - Jean M. Kerver
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48823, USA;
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McKay FH, Zinga J, van der Pligt P. Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study. Nutr Diet 2024; 81:228-236. [PMID: 37845189 DOI: 10.1111/1747-0080.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 10/18/2023]
Abstract
AIM To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy. METHOD Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand. RESULTS Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand. CONCLUSIONS AND IMPLICATIONS Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.
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Affiliation(s)
- Fiona H McKay
- Faculty of Health, School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Julia Zinga
- Faculty of Health, School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Paige van der Pligt
- Faculty of Health, The Institute for Physical Activity and Nutrition (IPAN) and School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
- Department of Nutrition, Western Health, Footscray, Victoria, Australia
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11
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Ngoutane RM, Murray-Kolb LE, Zoma R, Ouédraogo CT, van Zutphen KG, Bruning R, Razakandrainy A, Ransom E, Dalmiya N, Kraemer K, Kodish SR. A Comparative Analysis of Maternal Nutrition Decision-Making Autonomy During Pregnancy-An Application of the Food Choice Process Model in Burkina Faso and Madagascar. Food Nutr Bull 2024; 45:47-56. [PMID: 38126192 PMCID: PMC11047013 DOI: 10.1177/03795721231217554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Adequate nutrition has been cited as one of the most critical components for optimal health outcomes during pregnancy. Women in Burkina Faso and Madagascar experience high rates of undernutrition due to lack of knowledge, finances, cultural norms, and autonomy. Therefore, this study aimed (1) to describe typical maternal diets during pregnancy in Burkina Faso and Madagascar, (2) to understand the multilevel factors that influence women's nutrition decision-making, and (3) to explore the extent to which women have nutrition decision-making autonomy during pregnancy. METHODS This study was conducted between October 2020 and February 2021 in Burkina Faso and Madagascar. Semi-structured interviews, focus group interviews, and free lists were conducted among women of reproductive age and pregnant and lactating women. Textual data from interviews were recorded and translated verbatim from local languages into French. The Food Choice Process Model guided textual content analysis using Dedoose software. Free list data were analyzed using cultural domain analysis approaches. RESULTS In Burkina Faso and Madagascar, women primarily consumed staple foods such as rice and tô during pregnancy. Participants cited eating fruits and vegetables when available, while the animal source foods were rarely consumed. Across both contexts, nutrition during pregnancy was influenced by factors that impact food choices, such as social factors, resources, ideals, and personal factors. While women and men in Madagascar had more shared decision-making on critical domains such as finances, men were the primary decision-makers in most areas of inquiry (eg, finances) in Burkina Faso. CONCLUSIONS The lack of adequate diverse diet consumed during pregnancy is primarily due to important factors including social factors and resources. Understanding the ability for women to consume optimal diets during pregnancy is needed to target behavioral change in maternal nutrition programming.
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Affiliation(s)
| | | | | | | | | | - Rachel Bruning
- The Pennsylvania State University, University Park, PA, USA
| | | | | | - Nita Dalmiya
- United National Children’s Fund, New York, NY, USA
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Zinga J, van der Pligt P, McKay FH. Views and preferences of food-insecure pregnant women regarding food insecurity screening and support within routine antenatal care. Health Expect 2024; 27:e13956. [PMID: 39102650 PMCID: PMC10771804 DOI: 10.1111/hex.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Food insecurity is a public health concern that has profound impact on physical and mental health, and on social well-being. Pregnancy is a period in which food insecurity is likely to be particularly deleterious, due to the serious impact on both mother and child. Food insecurity is not routinely screened in antenatal healthcare settings, and the preferences of pregnant women regarding food insecurity screening and support are poorly understood. This study aimed to determine the views and preferences of food-insecure pregnant women regarding food insecurity screening and support within antenatal healthcare. METHODS This qualitative descriptive study used face-to-face semi-structured interviews, conducted in February and March 2023, to gain the views of purposively sampled food-insecure, pregnant women in Melbourne, Australia. Food insecurity was evidenced by an affirmative response to at least one of three assessment items in a screening questionnaire. Qualitative content analysis was conducted to summarise the views and preferences of women. RESULTS Nineteen food-insecure pregnant women were interviewed. Three themes were identified: (1) acceptability of being screened for food insecurity, (2) concerns about the consequences of disclosure and (3) preferences regarding food insecurity screening and supportive strategies that could be offered within an antenatal healthcare setting. CONCLUSION Women were accepting of food insecurity screening being conducted within routine healthcare. Women identified potential benefits of routine screening, such as feeling supported by their clinician to have a healthy pregnancy and less pressure to voluntarily ask for food assistance. Women gave suggestions for the implementation of food insecurity screening to optimise their healthcare experience, maintain their dignity and feel able to disclose within a safe and caring environment. These results indicate that food insecurity screening in the antenatal setting is likely to have support from pregnant women and is urgently needed in the interest of promoting optimal nutrition for women and children. PATIENT CONTRIBUTION Pregnant women with lived experience of food insecurity were purposively sampled to obtain their insights regarding screening and support within a pregnancy healthcare setting. Member-checking occurred following data collection, whereby all participants were offered the opportunity to review their interview transcript to ensure trustworthiness of the data.
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Affiliation(s)
- Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsRoyal Women's HospitalParkvilleVictoriaAustralia
| | - Paige van der Pligt
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityGeelongVictoriaAustralia
- Department of Nutrition and DieteticsWestern HealthFootscrayVictoriaAustralia
| | - Fiona H. McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
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Gilbert L, Raubenheimer D, Hibbert EJ, Nanan R. PsyNBIOsis: Investigating the Association between Maternal Gestational Diabetes, Mental Health, Diet and Childhood Obesity Risk: Protocol for a Prospective, Longitudinal, Observational Study. Nutrients 2023; 16:124. [PMID: 38201953 PMCID: PMC10781001 DOI: 10.3390/nu16010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with poorer maternal mental health (depression and anxiety). Maternal mental health and GDM are likely to influence diet, which in turn impacts the course of GDM. Maternal diet may also be directly or indirectly associated with changes in infant anthropometry. The aims of this study are to (1) examine the associations between maternal GDM, mental health and diet, and (2) evaluate the associations between these maternal factors, breastmilk composition and infant anthropometry. METHODS This prospective, observational, longitudinal cohort study compares a cohort of women with and without GDM. Maternal mental health and diet are assessed using validated questionnaires. Breastmilk composition is measured with the Human Milk Analyzer, and infant body composition is measured with air displacement plethysmography. SIGNIFICANCE AND IMPACT Once data have been collected, PsyNBIOsis will provide evidence for the associations between maternal mental health, GDM status and diet, and their impact on breastmilk composition and early infant growth. The results may inform the Developmental Origins of Health and Disease framework and provide data on which to build cost-effective interventions to prevent both the development of mental health issues in mothers and adverse growth patterns in infants.
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Affiliation(s)
- Leah Gilbert
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW 2751, Australia
| | - David Raubenheimer
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
- School of Life and Environmental Science, University of Sydney, Sydney, NSW 2003, Australia
| | - Emily J. Hibbert
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW 2751, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
- Nepean Hospital, Penrith, NSW 2747, Australia
| | - Ralph Nanan
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
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Agho KE, van der Pligt P. BMC pregnancy and childbirth - 'screening and management of food insecurity in pregnancy'. BMC Pregnancy Childbirth 2023; 23:862. [PMID: 38102589 PMCID: PMC10722775 DOI: 10.1186/s12884-023-06062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023] Open
Abstract
Addressing food insecurity during pregnancy is a major public health problem that demands guided interventions and translational research in public health. In this Editorial, we provide the context and invite contributions for our BMC Pregnancy and Childbirth Collection on Screening and management of food insecurity in pregnancy.
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Affiliation(s)
- Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW, 2560, Australia.
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa.
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3220, Australia
- Department of Nutrition and Dietetics, Western Health, Footscray, Australia
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Borawski EA, Goodwin MA, Glenn AC, Mundorf C, Fernandez LI, Larberg N, Gunzler DD, Lever JS. Study design and protocol for Nourishing Beginnings, an integrated service delivery model addressing food insecurity and social needs of low-income pregnant individuals. Contemp Clin Trials 2023; 133:107310. [PMID: 37586560 PMCID: PMC10592211 DOI: 10.1016/j.cct.2023.107310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Nourishing Beginnings is an integrated referral and service delivery model supporting Medicaid-eligible pregnant individuals by providing increased nutritional food access throughout pregnancy up to three months postpartum, through community health workers (CHW), who simultaneously address and provide support for social service needs of the client. METHODS To study the impact of possible interventions on food security, the program includes two distinct interventions each paired with traditional CHW services, nutrition educational materials, and provision of basic essential cooking tools. Interventions consist of either bi-weekly home food delivery from the local food bank or bi-weekly financial assistance with healthy food access navigation. The study population consists of 160 pregnant individuals (18 or older,<22 weeks pregnant; 80 per intervention arm) who were referred to a countywide Pathways Community HUB (HUB), a community-based care coordination network that uses an evidence-based model to connect at-risk individuals to resources that address medical, social, economic, and behavioral health needs. Key data collection occurs at baseline, eight weeks after intervention begins, near delivery (36-38 weeks gestation), and three months postpartum. Intervention groups are compared to each other as well as against HUB historical controls and a concurrent matched sample from local Medicaid data. CONCLUSION The goal of Nourishing Beginnings is to improve long-term health outcomes (i.e., maternal and infant) both directly and mediated through a set of proximal outcomes, including prenatal care, food security, diet and nutrition, reported race discrimination and psychosocial factors including depression, stress, healthy eating self-efficacy, and social support. Clinical Trials #: NCT05341960.
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Affiliation(s)
- Elaine A Borawski
- Department of Nutrition, Case Western Reserve University School of Medicine, 9(th) Floor, Biomedical Research Building, 10900 Euclid Avenue, Cleveland, OH 44113, United States of America; Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 4(th) Floor, BioEnterprise, 11000 Cedar Avenue, Cleveland, OH 44113, United States of America.
| | - Meredith A Goodwin
- Department of Nutrition, Case Western Reserve University School of Medicine, 9(th) Floor, Biomedical Research Building, 10900 Euclid Avenue, Cleveland, OH 44113, United States of America; Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 4(th) Floor, BioEnterprise, 11000 Cedar Avenue, Cleveland, OH 44113, United States of America
| | - Alissa C Glenn
- Greater Cleveland Food Bank, 13815 Coit Rd, Cleveland, OH 44110, United States of America
| | - Christopher Mundorf
- Better Health Partnership, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America
| | - Laura I Fernandez
- Department of Nutrition, Case Western Reserve University School of Medicine, 9(th) Floor, Biomedical Research Building, 10900 Euclid Avenue, Cleveland, OH 44113, United States of America; Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 4(th) Floor, BioEnterprise, 11000 Cedar Avenue, Cleveland, OH 44113, United States of America
| | - Ndidi Larberg
- Better Health Partnership, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America
| | - Douglas D Gunzler
- Department of Medicine, Population Health and Equity Research Institute, Center for Health Care Research & Policy, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Dr., Cleveland, OH 44109, United States of America
| | - Jonathan S Lever
- Better Health Partnership, 2500 MetroHealth Dr, Cleveland, OH 44109, United States of America
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McKay FH, Zinga J, van der Pligt P. Screening Food Insecure during Pregnancy: Pilot Testing an Effective Brief Tool for Use in an Australian Antenatal Care Setting. Nutrients 2022; 14:4633. [PMID: 36364895 PMCID: PMC9654102 DOI: 10.3390/nu14214633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 10/18/2023] Open
Abstract
The purpose of this research is: (1) to determine the prevalence of food insecurity among pregnant people using the 10-, 6-, and 2-item iterations of the USA Household Food Security Survey Module (HFSSM) and the single item measure, and (2) identify an appropriate combination of questions that could be used to identify food insecurity in a clinical setting for a population of people who are pregnant in Australia. Cross-sectional survey collecting self-reported data from pregnant people in Australia (open May 2021 to March 2022). Survey included demographic characteristics, including income/welfare use, education, age, pregnancy information, household size and composition, and two measures of food insecurity. In total, 303 participants were included in the analysis. Sensitivity and specificity of the various combinations of questions were conducted. Food insecurity was estimated using the single item, and the 2-item, 6-item, and 10-item versions of the HFSSM, food insecurity was 6.2%, 11.4%, 11.7%, and 14.3% respectively. Respondents who were living in households that were food insecure answered affirmatively to question one, two, or three of the HFSSM, with the combination of questions one and three showing the best sensitivity and specificity for the whole sample, as well as for those who have characteristics likely to lead to food insecurity. Further testing of the 2-items, comprised of items one and three from the HFSSM, need to be conducted with a larger and more diverse sample to determine if this is an appropriate screening tool in an antenatal clinical setting to determine food insecurity during pregnancy.
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Affiliation(s)
- Fiona H. McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- Royal Women’s Hospital, Parkville, VIC 3052, Australia
| | - Paige van der Pligt
- The Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- Department of Nutrition, Western Health, Footscray, VIC 3011, Australia
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McKay FH, Zinga J, van der Pligt P. Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study. BMC Health Serv Res 2022; 22:1231. [PMID: 36199090 PMCID: PMC9533284 DOI: 10.1186/s12913-022-08587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Food insecurity and hunger during pregnancy have significant implications for the health of the mother and baby. Assisting clinicians when they encounter women who are experiencing hunger or food insecurity during their pregnancy will increase the opportunity for better birth and pregnancy outcomes. At present there are no guidelines for Australian clinicians on how to do this. METHODS This study uses a modified Delphi technique, allowing diverse participation in the process, to create consensus on the ways to address and respond to food insecurity during pregnancy. This modified Delphi collected data via two rounds of consensus. The opinions collected from the first round were thematically categorised and grouped. The topics were integrated into the survey for the second round and circulated to participants. During the second round, priorities were scored by giving five points to the topic considered most important, and one point to the least important. RESULTS Through two rounds of consultation, the panel achieved consensus on how to identify food insecurity during pregnancy, with some clear items of consensus related to interventions that could be implemented to address food insecurity during pregnancy. Experts achieved consensus on items that have importance at the institution and policy level, as well as services that exist in the community. The consensus across the spectrum of opportunities for assistance, from the clinical, to community-provided assistance, and on to government policy and practice demonstrate the complexity of this issue, and the multipronged approach that will be required to address it. CONCLUSION This is the first time such a consultation with experts on hunger and food insecurity during pregnancy has been conducted in Australia. Items that achieved consensus and the importance of the issue suggest several ways forward when working with pregnant women who are hungry and/or food insecure.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia.
| | - Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia
- Department of Nutrition and Dietetics, Royal Women's Hospital, Parkville, VIC, Australia
| | - Paige van der Pligt
- The Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia
- Department of Nutrition Western Health, Footscray, Australia
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