Objective: To investigate the influence of food insecurity on women's stress, disordered eating, dietary fat intake, and weight during the postpartum period. Methods: The association between marginal food security and food insecurity-measured during pregnancy and postpartum-and stress, disordered eating, dietary fat intake, and weight at 3 and 12 months postpartum was estimated using multivariate linear regression, controlling for demographic and socioeconomic characteristics and health behaviors. Effect modification between level of food insecurity and prepregnancy weight status was assessed, hypothesizing a stronger association would be found among women who started pregnancy with overweight or obesity. Results: Food insecurity status during pregnancy was strongly associated with higher levels of stress, disordered eating, and dietary fat intake at 3 and 12 months postpartum; during the postpartum period, food insecurity was associated with these measures at 12 months postpartum. A significant interaction was found between level of food insecurity and prepregnancy weight status; food insecurity was associated with greater weight and BMI at 12 months only among women with overweight or obesity. Conclusions: In order to return to one's prepregnancy weight, women with overweight and obesity who face household food insecurity may need multipronged assistance that not only addresses having enough high-quality food, but also include stress reduction and eating behavior interventions.
Women residing in neighborhoods of low socioeconomic status are more likely to experience adverse reproductive outcomes; however, few studies explore which specific neighborhood features are associated with poor maternal health behaviors and pregnancy outcomes. Based upon our conceptual model, directly observed street-level data from four North Carolina US counties were used to create five neighborhood indices: physical incivilities (neighborhood degradation), social spaces (public space for socializing), walkability (walkable neighborhoods), borders (property boundaries), and arterial features (traffic safety). Singleton birth records (2001–2005) were obtained from the North Carolina State Center for Vital Statistics and maternal health behavior information (smoking, inadequate or excessive weight gain) and pregnancy outcomes (pregnancy-induced hypertension/pre-eclampsia, low birthweight, preterm birth) were abstracted. Race-stratified random effect models were used to estimate associations between neighborhood indices and women’s reproductive behaviors and outcomes. In adjusted models, higher amounts of physical incivilities were positively associated with maternal smoking and inadequate weight gain, while walkability was associated with lower odds of these maternal health behaviors. Social spaces were also associated with inadequate weight gain during pregnancy. Among pregnancy outcomes, high levels of physical incivilities were consistently associated with all adverse pregnancy outcomes, and high levels of walkability were inversely associated with pregnancy-induced hypertension and preterm birth for Non-Hispanic white women only. None of the indices were associated with adverse birth outcomes for Non-Hispanic black women. In conclusion, certain neighborhood conditions were associated with maternal health behaviors and pregnancy outcomes.
Gestational hypertension, pre-eclampsia and eclampsia are conditions that affect the health of both mothers and infants during and after pregnancy. Recent research indicates the importance of considering environmental, social and individual contributors to poor pregnancy outcomes. Our research examined particulate matter (PM) concentrations as one measure of environmental exposure and neighbourhood quality as one measure of the social environment. We used these measures, as well as maternal characteristics, to predict the risk of gestational hypertension (including pre-eclampsia and eclampsia). North Carolina Detailed Birth Record data for 2000-2003 were obtained and geocoded for all singleton births. Levels of PM(10) and PM(2.5) were determined using air quality data from the US Environmental Protection Agency. Information on a woman's residential neighbourhood was determined from 2000 Census data. Modified Poisson regression models clustered by tract were used to examine the associations between PM levels, neighbourhood deprivation and maternal characteristics with gestational hypertension. Analysis was restricted to women residing within 20 km of a PM monitor. Both PM(10) and PM(2.5) were associated with gestational hypertension; the risk ratios for an interquartile range (IQR) increase in exposure were 1.07 [95% confidence interval (CI) 1.04, 1.11] for PM(10) (IQR: 3.92 µg/m(3)) and 1.11 [95% CI 1.08, 1.15] for PM(2.5) (IQR: 2.24 µg/m(3)). Living in a neighbourhood with increased levels of deprivation was also associated with gestational hypertension. Any smoking during pregnancy, younger age and higher level of education were inversely associated with risk of gestational hypertension. Compared with non-Hispanic White women, non-Hispanic Black women were at higher risk of gestational hypertension, whereas Hispanic women were at lower risk. Increased levels of PM and neighbourhood deprivation, as well as certain individual characteristics, were associated with higher risk of gestational hypertension.
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