The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

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.

Psychosocial experiences of pregnant women living with HIV in Ibadan, Oyo State

Introduction

Pregnancy often intensifies psychological vulnerabilities in women living with HIV (WLHIV) due to increased stressors such as health concerns, infant infection risks, and the management of special neonatal needs like prophylactic antiretroviral care.

Methodology

The study was conducted in four HIV treatment centres with participant selection based on the following criteria: an Edinburgh Postnatal Depression Scale (EPDS) score of 13 or above, gestational age between 14 to 40 weeks, less than five years of antiretroviral therapy (ART) usage, and history of partner conflict. This research forms a more extensive study of stress and depression amongst pregnant and postpartum WLWH. In-depth interviews, ranging from 20 to 40 minutes, were conducted with 26 HIV-positive pregnant women in private rooms within selected antiretroviral clinics from October and December 2022.

Results and Discussion

The study discovered that the support received from healthcare providers concerning ART and Prevention of Mother-To-Child Transmission (PMTCT) practices alleviated women's fear of death and perinatal transmission which bolstered their involvement in HIV care and fostered the birth of children not infected with HIV. Women perceived monogamy as a protective measure against HIV contraction. Participants who reported having partners engaging in unsafe sexual practices expressed anger and blame. The observation of other women with similar experiences aided in coping mechanisms, reaffirming previous findings that knowing someone living with HIV helps to accept their status due to the comfort derived from shared experiences.

Conclusion

Healthcare providers attending to pregnant WLWH can alleviate psychological distress by reinforcing positive coping strategies. These include consistent psychological distress screenings in HIV clinics and relevant mental health evaluations with appropriate care referrals.

Pathways linking social support, self-efficacy, and exclusive breastfeeding among women in northern Uganda

Despite improvements in infant feeding practices over the past two decades, the prevalence of exclusive breastfeeding (EBF) is below global targets. Social support can create an enabling environment for recommended infant feeding practices such as EBF, but the types of social support most important for sustained EBF and their potential mechanisms of action have not been thoroughly characterized. We therefore aimed to assess the relationship between EBF-specific social support, EBF self-efficacy, and EBF at 1 and 3 months among postpartum women in northern Uganda. Women (n = 238, 36.2% living with HIV) were recruited during pregnancy. EBF, social support, and EBF self-efficacy were assessed at 1 and 3 months postpartum. Path analysis was used to assess relationships between these factors. Most mothers exclusively breastfed to 1 (80.8%) and 3 months postpartum (62.9%). EBF-specific, but not general, social support differed by EBF status. EBF-specific social support was associated with higher odds of EBF, which was almost fully mediated by EBF self-efficacy. That is, there was evidence that social support primarily influences EBF through its association with self-efficacy. In sum, EBF-specific social support and self-efficacy likely promote EBF and are modifiable factors that can be intervened upon.

Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices

Introduction

Food insecurity (FI), an inadequate access to healthy, affordable food, is a public health concern primarily driven by material hardship. Optimal antenatal nutrition promotes best health outcomes for the mother and baby. Pregnant women experiencing FI are less able to access healthy foods, increasing the risk of complications such as gestational diabetes and preterm labour. Little is known about the experiences of food-insecure pregnant women in obtaining sufficient, nutritious food, their perceptions regarding antenatal nutrition and how this contributes to their food choices.

Methods

This qualitative study conducted from August to November 2020, during the COVID-19 pandemic, examined the experiences and coping strategies of food-insecure pregnant women, and the factors influencing their food choices. Seven English-speaking food-insecure pregnant women participated in semi-structured interviews. Interview transcripts were thematically analysed, informed by grounded theory methodology.

Results

Three themes were identified through analysis of the interviews related to strategies that managed household food supply, factors that influenced food choices, and experiences of pregnancy during the COVID-19 pandemic. As a result of a limited food budget, pregnancy symptoms, the cognitive overload that attends the FI experience, and the acute yet significant impact of the pandemic, food-insecure pregnant women in this study defaulted to cheap and convenient food choices despite acknowledging the importance of eating well for pregnancy.

Conclusion

FI during pregnancy is burdensome, relentless and undermines women’s wellbeing. Supportive strategies within antenatal healthcare settings are urgently required to deliver an equitable health response for vulnerable women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-022-03440-3.

Risk factors for poor mental health among adolescent mothers in South Africa

In South Africa, high rates of adolescent pregnancy and HIV pose prominent public health challenges with potential implications for mental wellbeing. It is important to understand risk factors for mental health difficulties among adolescent mothers affected by HIV. This study aims to identify the prevalence of likely common mental disorder among adolescent mothers (both living with and not living with HIV) and explores hypothesised risk factors for likely common mental disorder. Cross-sectional data from adolescent mothers (10-19 years; n=1002) utilised within these analyses are drawn from a cohort of young mothers residing in the Eastern Cape Province, South Africa. All mothers completed a detailed questionnaire consisting of standardised measures of sociodemographic characteristics, mental health, and hypothesised risk factors. Logistic regression models were utilised to explore associations between hypothesised risk factors and likely common mental disorder. Risk factors were clustered within a hypothesised socioecological framework and entered into models using a stepwise sequential approach. Interaction effects with maternal HIV status were additionally explored. The prevalence of likely common mental disorder among adolescent mothers was 12.6%. Adolescent mothers living with HIV were more likely to report likely common mental disorder compared to adolescent mothers not living with HIV (16.2% vs 11.2%, X2=4.41, p=0.04). Factors associated with likely common mental disorder were any abuse exposure (OR=2.54 [95%CI:1.20-5.40], p=0.01), a lack of perceived social support (OR=4.09 [95%CI:2.48-6.74], p=<0.0001), and community violence exposure (OR=2.09 [95%CI:1.33-3.27], p=0.001). There was limited evidence of interaction effects between risk factors, and maternal HIV status. Violence exposure and a lack of perceived support are major risk factors for poor mental health among adolescent mothers in South Africa. Violence prevention interventions and social support may help to reduce risk. Identified risk factors spanning individual, interpersonal, and community levels have the potential to impact adolescent maternal mental health.

Household food insecurity and health in a high-migration area in rural Honduras

Household food insecurity (HFI) is a significant problem in the developing world. Relationships between HFI and nutrition, physical growth, and development have been elucidated; less is known about the non-nutritional impacts among individuals living in rural areas in low-income countries. The aim of this study was to determine if HFI is a risk factor for suboptimal mental health and overall health in rural Honduras. In a population of 24,696 adults with 176 isolated villages in western Honduras, we collected data on household food insecurity and physical and mental health outcome measures. Using logistic regression with and without adjusting for village and household level unobservables invariant across individual respondents, we show that females (OR: 1.11, p <0.01)), indigenous people (OR: 2:00, p < 0.01), and those planning to migrate (OR: 1.24, p <0.01) have higher odds of experiencing food insecurity. The risks of food insecurity and poor health were mitigated among respondents living where they were born and having multi-generations of relatives living in the same village-a measure of the opportunity and availability of social networks. Living in a food insecure compared to a food secure household was associated with 77 percent higher odds of being depressed, 35 percent higher odds of low overall mental health, and 20 percent higher odds for low overall health.

Prevalence and Covariates of Food Insecurity Across the First 1000 Days Among Women of Mixed HIV Status in Western Kenya: A Longitudinal Perspective

BACKGROUND

Food insecurity (FI) is common globally and can have lifelong consequences. However, few studies have longitudinally examined how FI varies across gestation and the postpartum period ("the first 1000 days"); none have explored this in sub-Saharan Africa or in the context of HIV.

OBJECTIVE

To assess the prevalence and covariates of FI in the first 1000 days among Kenyan women.

METHODS

All pregnant women attending 7 clinics in western Kenya (n = 1247) were screened for HIV and FI (Individual Food Insecurity Access Scale) between September 2014 and June 2015. A subset of women (n = 371) was recruited into an observational cohort study and surveyed 11 times through 2 years postpartum (NCT02974972, NCT02979418). Data on FI, sociodemographics, and health were repeatedly collected. Severe FI was modeled using multilevel, mixed-effects logistic regressions (n = 346).

RESULTS

Of the 1247 pregnant women screened, 76.5% were severely food insecure in the prior month. Further, the prevalence of severe FI was higher among women living with HIV than those without (82.6% vs 74.6%, P < .05). In the cohort, the odds of being severely food insecure decreased monotonically after delivery. Each point higher on the Center for Epidemiologic Studies-Depression scale was associated with 1.08 times greater odds of being severely food insecure (95% CI: 1.05-1.10); each point higher on the Duke/UNC Functional Social Support Scale was associated with 0.97 lower odds of severe FI (95% CI: 0.94-0.99).

CONCLUSIONS

Severe FI is prevalent during the first 1000 days in western Kenya. Services to mitigate the far-reaching consequences of this modifiable risk should be considered.

The impact of food insecurity on mental health in Africa: A systematic review

In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.

Association between food insecurity and depression among older adults from low- and middle-income countries

BACKGROUND

To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression.

CONCLUSIONS

In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

HIV-Exposed, Uninfected Infants in Uganda Experience Poorer Growth and Body Composition Trajectories than HIV-Unexposed Infants

BACKGROUND

HIV-uninfected infants of HIV-positive women may experience worse growth and health outcomes than infants of HIV-negative women, but this has not been thoroughly investigated under the World Health Organization's most recent recommendations to reduce vertical transmission.

OBJECTIVE

To determine whether HIV-exposed and -uninfected (HEU) infants whose mothers received Option B+ have higher odds of experiencing suboptimal growth trajectories than HIV-unexposed, -uninfected infants, and if this relationship is affected by food insecurity.

DESIGN

Repeated anthropometric measures were taken on 238 infants (HEU = 86) at 1 week and 1, 3, 6, 9, and 12 months after delivery in Gulu, Uganda. Latent class growth mixture modeling was used to develop trajectories for length-for-age z-scores, weight-for-length z-scores, mid-upper arm circumference, sum of skinfolds, and arm fat area. Multinomial logistic models were also built to predict odds of trajectory class membership, controlling for socioeconomic factors.

RESULTS

HEU infants had greater odds of being in the shortest 2 length-for-age z-scores trajectory classes [odds ratio (OR) = 3.80 (1.22-11.82), OR = 8.72 (1.80-42.09)] and higher odds of being in smallest sum of skinfolds trajectory class [OR = 3.85 (1.39-10.59)] vs. unexposed infants. Among HEU infants, increasing food insecurity was associated with lower odds of being in the lowest sum of skinfolds class [OR = 0.86 (0.76-0.98)].

CONCLUSIONS

There continues to be differences in growth patterns by HIV-exposure under the new set of World Health Organization guidelines for the prevention of mother-to-child transmission of HIV and the feeding of HEU infants in low-resource settings that are not readily identified through traditional mixed-effects modeling. Food insecurity was not associated with class membership, but differentially affected adiposity by HIV-exposure status.

Food Insecurity during Pregnancy in a Maternal-Infant Cohort in Brazilian Western Amazon

The aim of this study was to determine the prevalence and analyze the factors associated with food insecurity during gestation in a maternal-infant cohort in Brazilian Western Amazon. A population-based cross-sectional study was conducted with parturients from a maternal-infant cohort in Rio Branco, located in the Western Brazilian Amazon. The dependent variable food insecurity (FI) was obtained through the Brazilian Scale of Food Insecurity, and associated factors were identified through multiple logistic regression. The prevalence of FI in pregnancy was of 34.8%. Regarding severity, the prevalence of mild food insecurity was 24.6%, moderate food insecurity was 4.8%, and severe food insecurity was 5.4%. The factors directly associated with FI were the presence of open sewage in the peridomestic environment; belonging to the lower economic classes; being an income transfer program beneficiary, while the factors inversely associated with FI were schooling equal to or greater than 8 years; having a partner; primigestation; and regular consumption of fruits and vegetables during pregnancy. These findings reinforce the need for the ratification of actions aimed at the domestic economy in the income transfer programs and the development of actions of food and nutritional education in the gestational period.

Household food insecurity associated with gestacional and neonatal outcomes: a systematic review

BACKGROUND

Food insecurity (FI) occurs when people lack secure access to sufficient amounts of safe and nutritious food. FI has been associated with negative effects on human health, including during the prenatal and neonatal periods. The objective of this study is to evaluate the consequences of FI for pregnant women's and newborns' health.

METHODS

A literature search was performed with three independent researchers based on the PRISMA guidelines; the search covered the period of November 2008 to July 2019 and was conducted in the following databases: the US National Library of Medicine at the National Institutes of Health (PubMed), Latin American and Caribbean Health Sciences (LILACS), Cochrane Library, Web of Science, Embase, Scopus and OpenGrey. The terms and descriptors were defined by consulting the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) platforms and mainly included "food security", "food insecurity", "pregnancy" and "newborn". The studies were selected through a title and abstract review and then a reading of the full text. The quality of the studies and the risk of bias were analysed based on the criteria defined in the "Joanna Briggs Institute Reviewers' Manual" and by Guyatt and colleagues for interventional studies. The population, study design, FI measurement instruments, FI proportions, outcomes, confounders and results were extracted from the 37 studies that were selected according to the eligibility and quality criteria.

RESULTS

FI ​​proportions ranged from 5.2 to 87%. Most studies were conducted with African populations (42.2%) and applied globally used scales to assess FI (56.7%); 27% of the studies adapted scales. There were wide variations in the instruments used to estimate FI. The main outcomes related to FI included stress, anxiety and depression during pregnancy, followed by dietary quality and dietary diversity. Associations of FI with birth defects, neonatal mortality and the early introduction of animal milk to the infant's diet were also observed.

CONCLUSIONS

It is necessary to pay attention to the diversity of FI measurement instruments before FI results are compared. FI can be a risk factor for depression and stress during pregnancy, as well as for neonatal mortality, newborn health problems and breastfeeding interruption.

TRIAL REGISTRATION

This systematic review was registered on PROSPERO (CRD42018109478).

The Relationship between Household Food Insecurity and Depressive Symptoms among Pregnant Women: A Cross Sectional Study

Objective: There is growing evidence suggesting that household food insecurity (HFI) is associated with adverse outcomes on mental health; however, limited evidence exists for pregnant women. This study was conducted to determine the relationship between HFI and depressive symptoms among a sample of pregnant women. Method : This cross sectional study was performed on 394 pregnant women referring to the health centers located in Qom, Iran, from October 2017 to March 2019. HFI was evaluated using an 18-item US Household Food Security Survey Module. The Beck Depression Inventory-II questionnaire was applied to determine the severity of depressive symptoms. Logistic regression analysis was used to determine the factors associated with elevated depressive symptoms in the study population. Results: The mean (± standard deviation) age of the study population was 28.59 ± 7.28 years. Almost 48% of participants were food insecure, and 37% experienced elevated levels of depressive symptoms during pregnancy. The prevalence of elevated depressive symptoms was significantly higher in food-insecure (P < 0.001) and unemployed (P = 0.02) women, while it was significantly lower in women with higher education levels (P < 0.001). In the adjusted model, it was revealed that HFI was significantly associated with the higher likelihood of having elevated depressive symptoms (OR = 3.31, 95% CI = 2.07, 5.29), while the higher level of education was negatively associated with the levels of depressive symptoms (OR = 0.40, 95% CI = 0.20, 0.79). Conclusion: HFI was positively associated with the severity of depressive symptoms in a sample of pregnant women. Further studies are needed to confirm this finding. Meanwhile, routine screening of HFI for all pregnant women in the community health centers is recommended.

HIV infection, hunger, breastfeeding self-efficacy, and depressive symptoms are associated with exclusive breastfeeding to six months among women in western Kenya: a longitudinal observational study

BACKGROUND

Exclusive breastfeeding for the first six months of life is recommended for all infants. However, breastfeeding rates remain suboptimal; around 37% of infants are exclusively breastfed for the first six months globally. In Nyanza region, western Kenya, numerous challenges to breastfeeding have been identified, including food insecurity, hunger, depressive symptoms, and HIV infection. Yet, evidence to inform our understanding of how these problems influence women's breastfeeding behaviors across time is lacking. We therefore sought to examine these factors and how they interact to affect the initiation and duration of exclusive breastfeeding in this region. We hypothesized that women experiencing greater food insecurity, hunger, and/or depressive symptoms would be less likely to maintain exclusive breastfeeding for six months than women who were food secure or not depressed. We also hypothesized that women living with HIV would be more likely to maintain exclusive breastfeeding to six months compared to HIV-uninfected women.

METHODS

Women in Pith Moromo, a longitudinal cohort study in western Kenya, were surveyed at two antenatal and three postpartum timepoints (n = 275). Data were collected on breastfeeding behavior and self-efficacy, maternal food insecurity and hunger, maternal psychosocial health, and HIV status. Cox proportional hazards models were used to identify predictors of early exclusive breastfeeding cessation.

RESULTS

The majority of women (52.3%) exclusively breastfed for the first six months. In the final multivariable Cox proportional hazards model, living with HIV was associated with a 64% decrease in the rate of early exclusive breastfeeding cessation. Additionally, the rate of early exclusive breastfeeding cessation increased by 100 and 98% for those experiencing probable depression or hunger, respectively. Although there was no main effect of breastfeeding self-efficacy, the interaction between breastfeeding self-efficacy and hunger was significant, such that the rate of early exclusive breastfeeding cessation was predicted to decrease by 2% for every point increase in breastfeeding self-efficacy score (range: 0-56).

CONCLUSIONS

This study contributes to previous work demonstrating that women living with HIV more consistently exclusively breastfeed and suggests that rates of exclusive breastfeeding could be increased through targeted support that promotes maternal mental health and breastfeeding self-efficacy, while reducing maternal hunger.

TRIAL REGISTRATION

Study registration NCT02974972.

The role of social support in the psychological illness of women

OBJECTIVE

to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women.

METHOD

a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used.

RESULTS

there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network.

CONCLUSION

issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment.

Does social support modify the relationship between food insecurity and poor mental health? Evidence from thirty-nine sub-Saharan African countries

OBJECTIVE

The present study aimed to determine the relationship among food insecurity, social support and mental well-being in sub-Saharan Africa, a region presenting the highest prevalence of severe food insecurity and a critical scarcity of mental health care.

DESIGN

Food insecurity was measured using the Food Insecurity Experience Scale (FIES). Social support was assessed using dichotomous indicators of perceived, foreign perceived, received, given, integrative and emotional support. The Negative and Positive Experience Indices (NEI and PEI) were used as indicators of mental well-being. Multilevel mixed-effect linear models were applied to examine the associations between mental well-being and food security status, social support and their interaction, respectively, accounting for random effects at country level and covariates.ParticipantsNationally representative adults surveyed through Gallup World Poll between 2014 and 2016 in thirty-nine sub-Saharan African countries (n 102 235).

RESULTS

The prevalence of severe food insecurity was 39 %. The prevalence of social support ranged from 30 to 72 % by type. In the pooled analysis using the adjusted model, food insecurity was dose-responsively associated with increased NEI and decreased PEI. Perceived, integrative and emotional support were associated with lower NEI and higher PEI. The differences in NEI and PEI between people with and without social support were the greatest among the most severely food insecure.

CONCLUSIONS

Both food insecurity and lack of social support constitute sources of vulnerability to poor mental well-being. Social support appears to modify the relationship between food security and mental well-being among those most affected by food insecurity in sub-Saharan Africa.

Maternal and Child Supplementation with Lipid-Based Nutrient Supplements, but Not Child Supplementation Alone, Decreases Self-Reported Household Food Insecurity in Some Settings

Background: It is unknown whether self-reported measures of household food insecurity change in response to food-based nutrient supplementation.Objective: We assessed the impacts of providing lipid-based nutrient supplements (LNSs) to women during pregnancy and postpartum and/or to their children on self-reported household food insecurity in Malawi [DOSE and DYAD trial in Malawi (DYAD-M)], Ghana [DYAD trial in Ghana (DYAD-G)], and Bangladesh [Rang-Din Nutrition Study (RDNS) trial].Methods: Longitudinal household food-insecurity data were collected during 3 individually randomized trials and 1 cluster-randomized trial testing the efficacy or effectiveness of LNSs (generally 118 kcal/d). Seasonally adjusted Household Food Insecurity Access Scale (HFIAS) scores were constructed for 1127 DOSE households, 732 DYAD-M households, 1109 DYAD-G households, and 3671 RDNS households. The impact of providing LNSs to women during pregnancy and the first 6 mo postpartum and/or to their children from 6 to 18-24 mo on seasonally adjusted HFIAS scores was assessed by using negative binomial models (DOSE, DYAD-M, and DYAD-G trials) and mixed-effect negative binomial models (RDNS trial).Results: In the DOSE and DYAD-G trials, seasonally adjusted HFIAS scores were not different between the LNS and non-LNS groups. In the DYAD-M trial, the average household food-insecurity scores were 14% lower (P = 0.01) in LNS households than in non-LNS households. In the RDNS trial, compared with non-LNS households, food-insecurity scores were 17% lower (P = 0.02) during pregnancy and the first 6 mo postpartum and 15% lower (P = 0.02) at 6-24 mo postpartum in LNS households.Conclusions: The daily provision of LNSs to mothers and their children throughout much of the "first 1000 d" may improve household food security in some settings, which could be viewed as an additional benefit that may accrue in households should policy makers choose to invest in LNSs to promote child growth and development. These trials were registered at clinicaltrials.gov as NCT00945698 (DOSE) NCT01239693 (DYAD-M), NCT00970866 (DYAD-G) and NCT01715038 (RDNS).

The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study

Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied among Ugandan pregnant women with low vs. high SS. Cross-sectional data were collected among 403 pregnant women in northern Uganda. SS was assessed using an eight-item version of the Duke-UNC functional SS scale. FI and depressive symptoms were assessed by, respectively, the individually focused FI scale and the Center for Epidemiologic Studies-Depression scale. Women were categorized into two SS groups, based on scoring < or ≥ to the median SS value. Multivariate linear regression models indicated an independent association between FI and depressive symptoms severity. The association between FI and depressive symptoms severity was moderated by SS i.e. was stronger among women in the low SS category (adjusted beta (95%CI): 0.91 (0.55; 1.27)) than for women belonging to the high SS group (0.53 (0.28; 0.78)) (adjusted p value for interaction = 0.026). There is need for longitudinal or interventional studies among pregnant women living in northern Uganda or similar contexts to examine the temporal sequence of the associations among food insecurity, depressive symptoms severity and social support. © 2016 John Wiley & Sons Ltd.

Investigating tangible and mental resources as predictors of perceived household food insecurity during pregnancy among women in a South African birth cohort study

RATIONALE

Food insecurity during pregnancy is concerning given the increased nutritional needs of the mother for proper fetal development. However, research is lacking within the South African context to investigate the association of economic and psychosocial factors and food insecurity among pregnant women, using comprehensive, conceptually driven models.

OBJECTIVE

This study applies the Network-Individual-Resource (NIR) Model to investigate individual, intimate dyadic, and family level predictors of perceived household food insecurity for pregnant women.

METHODS

826 pregnant women enrolled in the Drakenstein Child Health Study (DCHS), a birth cohort in two communities in a peri-urban area of South Africa. Hierarchical logistic regressions were used to investigate the impact of household/family, intimate dyads, and individual tangible and mental resources on perceived household food insecurity during the critical period of pregnancy. Perceived household food insecurity was assessed through an adapted version of the USDA Household Food Security Scale - Short Form.

RESULTS

Among 826 pregnant women in South Africa, individual-level tangible resources (e.g. income, social assistance, HIV status) and mental resources (e. g. depression, childhood trauma) predicted perceived household food insecurity and these predictors differed by community. Intimate dyadic and family level resources did not predict household food insecurity.

CONCLUSIONS

Our findings of the economic and psychosocial predictors of perceived household food insecurity among pregnant women in South Africa, mirror findings in general populations. This study provides support for the extension of the NIR model to perceived household food insecurity, particularly regarding individual-level mental and tangible resources, as well as the impact of community-level factors. Future research should investigate the extent to which resource sharing occurs within networks.

Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda

Background

In sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women.

Methods

We conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis.

Results

Twenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm³ (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality.

Conclusions

The results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.

Food insecurity, but not HIV-infection status, is associated with adverse changes in body composition during lactation in Ugandan women of mixed HIV status

BACKGROUND

Body composition is an important indicator of nutritional status and health. How body composition changes during 12 mo of breastfeeding in HIV-infected women receiving antiretroviral therapy (ART) is unknown.

OBJECTIVE

We assessed whether HIV or food insecurity was associated with adverse postpartum body-composition changes in Ugandan women.

DESIGN

A cohort of 246 women [36.5% of whom were HIV positive (HIV+) and were receiving ART] were followed to 12 mo postpartum. Repeated measures included weight, fat mass, fat-free mass, midupper arm circumference, triceps skinfold thickness [which allowed for the derivation of arm muscle area (AMA) and arm fat area (AFA)], breastfeeding, and individual food insecurity. Longitudinal regression models were constructed to assess associations between HIV and food insecurity and changes in body composition over time.

RESULTS

At baseline, HIV+ women compared with HIV-negative women had a higher mean ± SD food-insecurity score (11.3 ± 5.5 compared with 8.6 ± 5.5, respectively; P < 0.001) and lower AMA (40.6 ± 5.7 compared with 42.9 ± 6.9 cm³, respectively; P = 0.03). Participants were thin at 1 wk postpartum [body mass index (BMI; in kg/m²): 22.9 ± 2.9]. From 1 wk to 12 mo, the weight change was -1.4 ± 4.4 kg. In longitudinal models of body-composition outcomes, HIV was not associated with body composition (all P > 0.05), whereas food insecurity was inversely associated with body weight and BMI at 6, 9, and 12 mo and with AFA at 6 and 12 mo (all P < 0.05). At 6 mo, every 1-unit increase in the food-insecurity score was associated with a 0.13-kg lower body weight (P < 0.001) and a 0.26-cm³ lower AFA (P < 0.01).

CONCLUSIONS

Body-composition changes are minimal during lactation. HIV is not associated with body composition; however, food insecurity is associated with changes in body composition during lactation. This trial was registered at clinicaltrials.gov as NCT02922829 and NCT02925429.