Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto

What tools are available to assess climate and environmental health impacts on perinatal families with an equity lens? A rapid review of the Canadian context

OBJECTIVES

This rapid review is designed to identify existing tools in the Canadian literature that assess the impacts of climate change on the health of perinatal families, particularly those who are equity-denied. Addressing the needs of equity-denied perinatal populations in the face of climate change is crucial to promoting equitable and inclusive perinatal care in Canada.

METHODS

Rapid review methodology was selected to provide evidence in a timely and cost-effective manner. PubMed/MEDLINE and gray literature (Google and Google Scholar) were searched for English and French papers published from 2013 onward. The original research question, focused on climate change and health, yielded very few relevant results. Therefore, the search was broadened to include environmental health. Garrity et al.'s (J Clin Epidemiol 130:13-22, 2021) nine-stage process was used to identify 11 relevant papers, extract the relevant data, and complete the narrative synthesis.

SYNTHESIS

This review revealed a significant lack of tools for comprehensively assessing climate-health impacts on perinatal families and equity-denied perinatal families. While Canadian perinatal health screenings focus on equity via indicators of several social determinants of health (e.g., income, social support), they largely omit climate considerations. Environmental health factors are more commonly included but remain minimal.

CONCLUSION

Climate-health screening tools are lacking yet needed in routine perinatal healthcare. Given the seriousness of climate change, urgent engagement of health systems and healthcare workers is essential to help mitigate and adapt to climate-health challenges, particularly for perinatal families experiencing health inequities.

Complex intertwined association between breastfeeding practices and household food insecurity: Systematic review and meta-analysis

Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.

The Association Between Prenatal Food Insecurity and Breastfeeding Initiation and Exclusive Breastfeeding Duration: A Longitudinal Study Using Oregon PRAMS and PRAMS-2, 2008-2015

Background: In the United States, 11.1% of households experience food insecurity; however, pregnant women are disproportionately affected. Maternal food insecurity may affect infant feeding practices, for example, through being a source of chronic stress that may alter the decision to initiate and continue breastfeeding. Thus, we sought to determine whether prenatal food insecurity was associated with breastfeeding (versus not) and exclusive breastfeeding duration among Oregon women. Method: The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 2008 to 2015 and the Oregon PRAMS-2 follow-up survey were used (n = 3,624) in this study. Associations with breastfeeding initiation and duration were modeled with multivariable logistic regression and accelerated failure time (AFT), respectively. Models were adjusted for maternal sociodemographic and pre-pregnancy health characteristics. Results: Nearly 10% of women experienced prenatal food insecurity. For breastfeeding initiation, unadjusted models suggested non-significant decreased odds (odds ratio (OR) 0.88 [confidence intervals (CI): 0.39, 1.99]), whereas adjusted models revealed a non-significant increased odds (OR 1.41 [CI: 0.58, 3.47]). Unadjusted AFT models suggested that food-insecure mothers had a non-significant decrease in exclusive breastfeeding duration (OR 0.76 [CI: 0.50, 1.17]), but adjustment for covariates attenuated results (OR 0.89 [CI: 0.57, 1.39]). Conclusions: Findings suggest minimal differences in breastfeeding practices when exploring food security status in the prenatal period, though the persistence of food insecurity may affect exclusive breastfeeding duration. Lower breastfeeding initiation may be due to other explanatory factors correlated with food insecurity and breastfeeding, such as education and marital status.

Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum

Background

Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions.

Methods

We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics.

Results

Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98).

Conclusion

HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.

Trends, Prevalence, and Risk Factors of Food Insecurity Among Pregnant and Postpartum Women in the United States: Findings from the 2019-2021 National Health Interview Survey

Background: Despite the widespread food insecurity in the United States, there is limited research investigating its prevalence among pregnant women and the potential impact it has on maternal and child health outcomes. This study examined trends in the prevalence of, and investigated risk factors for, food insecurity among peripartum women, using a nationally representative sample in the United States. Materials and Methods: This cross-sectional study included pregnant and postpartum women aged 18-49 years who reported being currently pregnant or pregnant in the past 12 months and who participated in the National Health Interview Survey from 2019 to 2021. Weighted multivariable logistic regression analysis was used to estimate associations with food insecurity. Results: A total of 1,527 pregnant women, weighted to represent 5,588,192 women in the United States, were included in the analysis. Overall, from 2019 to 2021, 10.8% of peripartum women were food insecure. The prevalence of food insecurity changed substantially between 2019 and 2021 (2019: 10.6% confidence interval [95% CI: 8.7-13.5], 2020: 16.0% [95% CI: 10.9-22.8], 2021: 6.2% [95% CI: 4.2-9.1]). The adjusted odds of food insecurity were significantly higher among pregnant and postpartum women in 2020 (aOR 2.15), who had a health insurance coverage (aOR 2.98) and who had an unmet health care need in the preceding 12 months (aOR 6.52). Conclusion: We found that food insecurity was common among peripartum women between 2019 and 2021 and was exacerbated by the COVID-19 pandemic. Identifying the factors that predispose peripartum women to the risk of food insecurity can guide the development and implementation of targeted interventions aimed at reducing the adverse impact of food insecurity on perinatal and infant health.