Association of community-level food insecurity and glycemic control among pregnant individuals with pregestational diabetes

Kartik K. Venkatesh*, Joshua J. Joseph, Aaron Clark, Steven G. Gabbe, Mark B. Landon, Stephen F. Thung, Lynn M. Yee, Courtney D. Lynch, William A. Grobman, Daniel M. Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Aim: To evaluate whether pregnant individuals with pregestational diabetes who live in a food-insecure community have worse glycemic control compared to those who do not live in a food-insecure community. Methods: A retrospective analysis of pregnant individuals with pregestational diabetes enrolled in a multidisciplinary prenatal and diabetes care program. The exposure was community-level food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy. Results: Among 418 assessed pregnant individuals with pregestational diabetes, those living in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted risk ratio (aRR): 0.55; 95 % CI: 0.33–0.92]. Individuals living in a food-insecure community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR: 1.55; 95 % CI: 1.06–2.28] and a larger mean decrease in A1c across pregnancy [mean: 1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06–0.87)]. Conclusions: Pregnant individuals with pregestational diabetes who lived in a food-insecure community were less likely to enter pregnancy with glycemic control, but were more likely to have a reduction in A1c and achieve similar A1c status compared to those who lived in a community without food insecurity. Whether interventions that address food insecurity improve glycemic control and consequent perinatal outcomes remains to be studied.

Original languageEnglish (US)
Pages (from-to)73-78
Number of pages6
JournalPrimary Care Diabetes
Volume17
Issue number1
DOIs
StatePublished - Feb 2023

Keywords

  • Diabetes
  • Food insecurity
  • Glycemic control
  • Low food access
  • Pregestational diabetes
  • Pregnancy

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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