(PS10-95) Conceptualizing Food Insecurity During Pregnancy Through Community-engaged, Mixed-methods Research: Food Access Disruptions and Associated Distress

Background: Food insecurity, typically defined as having limited or uncertain access to sufficient food, affects 20% of U.S. pregnant individuals and is associated with adverse perinatal mental health, including depressive and anxiety symptoms. Conventional conceptualizations of food insecurity do not account for unique experiences of pregnancy (e.g., changes in nutritional needs, appetite, mood, and physical functioning) that are relevant to food insecurity, limiting the accurate identification of and support for pregnant individuals with food insecurity. As such, this mixed-methods, community-engaged study aimed to (1) explore how pregnancy uniquely affects the experience of food insecurity, and (2) identify the core features of prenatal food insecurity through iterative focus groups and surveys.

Method: Participants (N = 43; 91% Black-identifying; 58% WIC participants; 30.31+3.66 years old; 14.18+9.96 weeks gestation) were pregnant individuals living in the U.S. who endorsed food insecurity on the two-item Hunger Vital Signs measure. A PhD-level researcher facilitated four iterative, virtual 90-minute focus groups. Participants also completed validated questionnaires of food insecurity (e.g., USDA Food Security Survey Modules), depressive (CES-D) and anxiety (STAI) symptoms. Focus group transcripts were analyzed using framework analysis, supplemented by survey data to enhance data triangulation and sample characterization.     

Results: Findings suggested that pregnancy distinctly alters the experience of food insecurity.  Key alterations related to pregnancy included: food access challenges (e.g., pregnancy fatigue limits the ability to walk to affordable stores), difficulty rationing food (e.g., due to increased hunger and desire to ensure nutrition adequacy for the developing baby), and increased distress related to food insecurity (e.g., heightened worry about consequences of food insecurity; increased food insecurity stigma).  The core features of prenatal food insecurity fell under two primary themes, with subthemes of each: (1) disruptions to food access and (2) associated distress. Within disruptions to food access, three subthemes emerged: insufficient food quantity, insufficient nutrition quality, and insufficient preferred foods. Four subthemes emerged under distress: psychological distress (e.g., negative emotions and associated behaviors), stigma (external and internalized), cognitive labor (e.g., planning for food access), and physiological distress (e.g., increased food cravings/hunger). A theme of desired support also emerged, with individuals noting that they desired safe spaces to talk about food insecurity with other pregnant individuals, as well as mental health check-ins from medical providers, given the emotional toll of food insecurity.

Discussion: Findings underscore the psychological impact of prenatal food insecurity, emphasizing the need for tailored support interventions. Understanding these nuances is essential for addressing the complex interplay between food insecurity and perinatal mental health, ultimately fostering holistic care for pregnant individuals.