Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women

Household food insecurity has been associated with several negative health outcomes, yet little is known about the prevalence and correlates of household food insecurity during pregnancy. This study was conducted as part of the Pregnancy, Infection, and Nutrition prospective cohort study to identify risk factors of preterm birth. The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes <= 400% of poverty. Descriptive statistics and logistic regression were used to identify socioeconomic, demographic, and psychosocial predictors of household food insecurity. Among 606 pregnant women, 75% were from fully food-secure, 15% from marginally food-secure, and 10% from food-insecure households. Women from marginally food-secure and food-insecure households had significantly less income, less education, and were older than women from fully food-secure households. In bivariate analysis, all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity. Socioeconomic and demographic predictors for household food insecurity were income, black race, and age. After controlling for socioeconomic and demographic variables, psychosocial indicators of perceived stress, trait anxiety, and depressive symptoms, and a locus of control attributed to chance were positively associated with any household food insecurity. Conversely, self-esteem and mastery were inversely associated with any household food insecurity. Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women; however, the direction of causation between psychosocial indicators and food insecurity cannot be determined in these data.