Food Insecurity During Pregnancy and Breastfeeding by Low-Income Hispanic Mothers

Rachel S Gross, Alan L Mendelsohn, Mayela M Arana, Mary Jo Messito, Rachel S Gross, Alan L Mendelsohn, Mayela M Arana, Mary Jo Messito

Abstract

Background and objectives: Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines.

Methods: We performed purposive sampling of low-income Hispanic mothers (n = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached.

Results: Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies.

Conclusions: Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

References

    1. Ogden CL, Carroll MD, Lawman HG, et al. . Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315(21):2292–2299
    1. Guerrero AD, Mao C, Fuller B, Bridges M, Franke T, Kuo AA. Racial and ethnic disparities in early childhood obesity: growth trajectories in body mass index. J Racial Ethn Health Disparities. 2016;3(1):129–137
    1. Gillman MW, Rifas-Shiman SL, Kleinman K, Oken E, Rich-Edwards JW, Taveras EM. Developmental origins of childhood overweight: potential public health impact. Obesity (Silver Spring). 2008;16(7):1651–1656
    1. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr. 2006;95(8):904–908
    1. Anderson SA. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(suppl 11):1559–1600
    1. Braveman P, Marchi K, Egerter S, et al. . Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J. 2010;14(1):20–35
    1. Ivers LC, Cullen KA. Food insecurity: special considerations for women. Am J Clin Nutr. 2011;94(6):1740S–1744S
    1. Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136(1):177–182
    1. Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, Gortmaker SL. Simulation of growth trajectories of childhood obesity into adulthood. N Engl J Med. 2017;377(22):2145–2153
    1. DiSantis KI, Hodges EA, Johnson SL, Fisher JO. The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int J Obes. 2011;35(4):480–492
    1. Hurley KM, Cross MB, Hughes SO. A systematic review of responsive feeding and child obesity in high-income countries. J Nutr. 2011;141(3):495–501
    1. Bronte-Tinkew J, Zaslow M, Capps R, Horowitz A, McNamara M. Food insecurity works through depression, parenting, and infant feeding to influence overweight and health in toddlers. J Nutr. 2007;137(9):2160–2165
    1. Gross RS, Mendelsohn AL, Fierman AH, Racine AD, Messito MJ. Food insecurity and obesogenic maternal infant feeding styles and practices in low-income families. Pediatrics. 2012;130(2):254–261
    1. Gross RS, Mendelsohn AL, Gross MB, Scheinmann R, Messito MJ. Material hardship and internal locus of control over the prevention of child obesity in low-income Hispanic pregnant women. Acad Pediatr. 2016;16(5):468–474
    1. Gross RS, Mendelsohn AL, Messito MJ. Additive effects of household food insecurity during pregnancy and infancy on maternal infant feeding styles and practices. Appetite. 2018;130:20–28
    1. Laraia B, Vinikoor-Imler LC, Siega-Riz AM. Food insecurity during pregnancy leads to stress, disordered eating, and greater postpartum weight among overweight women. Obesity (Silver Spring). 2015;23(6):1303–1311
    1. Orr SK, Dachner N, Frank L, Tarasuk V. Relation between household food insecurity and breastfeeding in Canada. CMAJ. 2018;190(11):E312–E319
    1. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79(1):6–16
    1. Woo Baidal JA, Criss S, Goldman RE, Perkins M, Cunningham C, Taveras EM. Reducing Hispanic children’s obesity risk factors in the first 1000 days of life: a qualitative analysis. J Obes. 2015;2015:945918.
    1. Gross RS, Mendelsohn AL, Gross MB, Scheinmann R, Messito MJ. Randomized controlled trial of a primary care-based child obesity prevention intervention on infant feeding practices. J Pediatr. 2016;174:171–177.e2
    1. Cook JT, Black M, Chilton M, et al. . Are food insecurity’s health impacts underestimated in the U.S. population? Marginal food security also predicts adverse health outcomes in young U.S. children and mothers. Adv Nutr. 2013;4(1):51–61
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Measuring Food Security in the United States: Guide to Measuring Household Food Security. Washington, DC: USDA; 2000
    1. Glaser B. The constant comparative method of qualitative analysis. Soc Probl. 1965;12(4):436–445
    1. Bureau of the Census Survey of Income and Program Participation (SIPP) 1993 Panel, Longitudinal File. Washington, DC: Bureau of the Census; 1997
    1. Council on Community Pediatrics; Committee on Nutrition . Promoting food security for all children. Pediatrics. 2015;136(5). Available at:
    1. Hanson KL, Connor L, Olson CM, Mills G. Household instability and unpredictable earnings hinder coping in households with food insecure children. J Poverty. 2016;20(4):464–483
    1. Jacknowitz A, Morrissey T, Brannegan A. Food insecurity across the first five years: triggers of onset and exit. Child Youth Serv Rev. 2015;53:24–33
    1. Quandt SA, Shoaf JI, Tapia J, Hernández-Pelletier M, Clark HM, Arcury TA. Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger. J Nutr. 2006;136(10):2638–2644
    1. Younginer NA, Blake CE, Draper CL, Jones SJ. Resilience and hope: identifying trajectories and contexts of household food insecurity. J Hunger Environ Nutr. 2015;10(2):230–258
    1. Munger AL, Lloyd TD, Speirs KE, Riera KC, Grutzmacher SK. More than just not enough: experiences of food insecurity for Latino immigrants. J Immigr Minor Health. 2015;17(5):1548–1556
    1. Held ML, Padilla YC. Enduring immigrant ties: supporting families left behind. Int Soc Work. 2016;59(4):523–532
    1. Laraia BA, Siega-Riz AM, Gundersen C. Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. J Am Diet Assoc. 2010;110(5):692–701
    1. Gross RS, Mendelsohn AL, Messito MJ. Prenatal material hardship and the internal locus of control over the prevention of child obesity: progress report. Acad Pediatr. 2018;18(6):603–604
    1. Bravi F, Wiens F, Decarli A, Dal Pont A, Agostoni C, Ferraroni M. Impact of maternal nutrition on breast-milk composition: a systematic review. Am J Clin Nutr. 2016;104(3):646–662
    1. Barrera C, Valenzuela R, Chamorro R, et al. . The impact of maternal diet during pregnancy and lactation on the fatty acid composition of erythrocytes and breast milk of Chilean women. Nutrients. 2018;10(7):839–853
    1. Valentine CJ, Wagner CL. Nutritional management of the breastfeeding dyad. Pediatr Clin North Am. 2013;60(1):261–274
    1. Heinrichs M, Neumann I, Ehlert U. Lactation and stress: protective effects of breast-feeding in humans. Stress. 2002;5(3):195–203
    1. Grey KR, Davis EP, Sandman CA, Glynn LM. Human milk cortisol is associated with infant temperament. Psychoneuroendocrinology. 2013;38(7):1178–1185
    1. Ritchie-Ewing G, Mitchell AM, Christian LM. Associations of maternal beliefs and distress in pregnancy and postpartum with breastfeeding initiation and early cessation. J Hum Lact. 2019;35(1):49–58
    1. Dozier AM, Nelson A, Brownell E. The relationship between life stress and breastfeeding outcomes among low-income mothers. Adv Prev Med. 2012;2012:902487.
    1. Kaiser LL, Melgar-Quiñonez H, Townsend MS, et al. . Food insecurity and food supplies in Latino households with young children. J Nutr Educ Behav. 2003;35(3):148–153
    1. Clark HR, Goyder E, Bissell P, Blank L, Peters J. How do parents’ child-feeding behaviours influence child weight? Implications for childhood obesity policy. J Public Health (Oxf). 2007;29(2):132–141
    1. Godefroy V, Champel C, Trinchera L, Rigal N. Disentangling the effects of parental food restriction on child’s risk of overweight. Appetite. 2018;123:82–90
    1. Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press; 2011
    1. Daniels SR, Hassink SG; Committee on Nutrition . The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136(1). Available at:
    1. Heberlein EC, Frongillo EA, Picklesimer AH, Covington-Kolb S. Effects of group prenatal care on food insecurity during late pregnancy and early postpartum. Matern Child Health J. 2016;20(5):1014–1024
    1. Beck AF, Henize AW, Kahn RS, Reiber KL, Young JJ, Klein MD. Forging a pediatric primary care-community partnership to support food-insecure families. Pediatrics. 2014;134(2). Available at:

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa