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. 2023 Feb;17(1):73-78.
doi: 10.1016/j.pcd.2022.11.002. Epub 2022 Nov 12.

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

Kartik K Venkatesh  1 , Joshua J Joseph  2 , Aaron Clark  3 , Steven G Gabbe  4 , Mark B Landon  5 , Stephen F Thung  5 , Lynn M Yee  6 , Courtney D Lynch  4 , William A Grobman  4 , Daniel M Walker  3
Affiliations

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

Kartik K Venkatesh et al. Prim Care Diabetes. 2023 Feb.

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.

Keywords: Diabetes; Food insecurity; Glycemic control; Low food access; Pregestational diabetes; Pregnancy.

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Conflict of interest statement

Conflict of interest None of the authors report a conflict of interest.

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