Food Deserts Linked to Greater Pregnancy Morbidity

Tara Haelle

June 15, 2020

Living in a neighborhood lacking adequate access to affordable high-quality food is associated with a modestly greater risk of developing a pregnancy morbidity, according to a retrospective observational study published in Obstetrics & Gynecology.

Previous research has linked so-called "food deserts" to higher systolic blood pressure and an increased risk of cardiovascular events in people with coronary artery disease, the authors note.

"Research on populations in the United States confirm that increased access to supermarkets is associated with lower prevalence of overweight and obesity, and improved fruit and vegetable consumption," said Matthew J. Tipton, MD, of Loyola University Medical Center in Chicago, and colleagues.

"With our study showing an association between living in a food desert and increased pregnancy morbidity, it is our hope that with future work, an unhealthy food environment could prove to be a modifiable factor that does contribute to disparities in pregnancy morbidity," the authors said. "Perhaps then, one could question whether greater access to healthier foods could reduce unexplained pregnancy morbidity for this population of patients," paving the way toward developing interventions that can then improve vulnerable women's health.

The researchers reviewed the electronic medical records of all the pregnant patients who delivered at Loyola University Medical Center in 2014. To determine who lived in a food desert, the authors relied on data about grocery food availability within Census tracts from the U.S. Department of Agriculture Food Access Research Atlas.

Dr. Tipton and associates defined living in a food desert as living in a low-income Census tract "where at least 33% of the population is more than half a mile from the nearest large grocery store for an urban area or more than 10 miles for a rural area." Low-income Census tracts are those where "at least 20% of the population has a median family income at or below 80% of the metropolitan area or state median income."

The authors compared women's residence within a food desert (or not) with six different pregnancy morbidities: preeclampsia, gestational hypertension, gestational diabetes, prelabor rupture of membranes, preterm labor, and intrauterine growth restriction.

Among 1,001 deliveries, about 1 in 5 women (20%) lived in a food desert. These women tended to be slightly younger than those not living in a food desert (28 vs. 30 years old), and a higher proportion of women in food deserts were black (44%) rather than white (32%). They also had a lower average income ($44,694) than those not living in food deserts ($67,005).

After adjustment for age, race, and medical insurance type (private, Medicaid, other), the researchers found that women who lived in a food desert had 1.6 times greater odds of pregnancy comorbidity than if they did not (odds ratio, 1.64; P = .004). Nearly half the women living in food deserts had any type of comorbidity (47%), compared with just over a third of women who did not (36%).

Among the six comorbidities studied, preterm rupture of membranes was significantly different before adjustment between those who lived in food deserts (16%) and those who did not (10%) (P = .015). An association with preeclampsia had borderline significance before adjustment: 13% of women in food deserts had preeclampsia, compared with 9% of women not (P = .049). After adjustment for age, race, and medical insurance, however, neither of these associations retained statistically significant differences.

The study was limited by leaving out consideration of other factors besides local food access that might influence pregnancy health, including "quality of patient-doctor communication, implicit bias, structural racism, and stress owing to concern for neighborhood safety," Dr. Tipton and associates said.

"An additional, albeit less obvious factor that may be unique to patients suffering disproportionately from obstetric morbidity is exposure to toxic elements," the researchers add. "It has been shown in a previous study that low-income, predominately black communities of pregnant women may suffer disproportionately from lead or arsenic exposure."

The study did not note external funding, and the authors reported no relevant financial disclosures.

SOURCE: Tipton MJ et al. Obstet Gynecol. 2020. doi: 10.1097/AOG.0000000000003868.

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