Nutritional Barriers in Maternal Health: The Impact of Food Insecurity on Gestational Diabetes and Polyhydramnios

Purpose: To explore associations between food insecurity (FI), gestational diabetes mellitus (GDM), and polyhydramnios in North Louisiana (LA) mothers, specifically in racially diverse and economically disadvantaged populations. Methods: A cross-sectional study was conducted from 2018 to 2023 among pregnant women receiving care at multiple obstetric units in a large, academic tertiary care health system providing services to patients across North LA. The study included patients from both urban and rural regions, permitting for the sample to be generalizable to North LA. Data was extracted from the electronic medical records (Epic) and categorized based on diagnoses of interest as determined by ICD-10 codes and FI status, as determined by the validated, two-question Hunger Vital Sign questionnaire. Diagnoses of interest included GDM (ICD-O24) and polyhydramnios (ICD-O40). Analyses were performed in jamovi using Chi-squared (X2) tests and Odds Ratios (ORs) within a 95% confidence interval (CI) for maternal FI and diagnoses, with additional stratification by race and age. Age categories were defined as optimal reproductive age (18-34), advanced maternal age (AMA, 35-39), very AMA (40-44), and extreme AMA (45-50). Results: The patient population (n=2,642) consisted of 58% African American (AA) women and 42% other, non-Black women.72% of patients were of optimal reproductive age, 19% of AMA, 7% of very AMA, and 2% of extreme AMA. Analysis revealed statistically significant associations in food-insecure mothers experiencing both GDM and polyhydramnios concurrently (OR=3.47, 95% CI, 1.46–8.21, p=0.003), with a diagnosis of polyhydramnios without GDM (OR=1.75, 95% CI, 1.05–2.90, p=0.027), and with a diagnosis of GDM without polyhydramnios (OR=1.29, 95% CI, 1.05–1.83, p=0.020). Stratifying by race and age, significant associations for food-insecure Black women with concurrent GDM and polyhydramnios were observed in those of optimal reproductive age (OR=4.39, 95% CI, 1.09–17.6, p=0.023). This association was not statistically significant in other races. No significant associations for GDM and polyhydramnios concurrently were observed in any race of AMA, very AMA, or extreme AMA. There were no cases of GDM and polyhydramnios in non-Black, extreme AMA women; thus, associations in this group could not be evaluated. Statistically significant associations were observed in food-insecure Black women with a diagnosis of polyhydramnios without concurrent GDM in those of optimal reproductive age (OR=0.377, 95% CI, 0.163–0.869, p=0.017); this association was not significant in other races. No significant associations were observed in Black women with polyhydramnios alone in those of AMA, very AMA, or extreme AMA. A significant association was observed in non-Black women of AMA with polyhydramnios alone (OR=6.38, 95% CI, 1.71–23.9, p=0.002), but not in non-Black, very AMA women. There were no cases in non-Black, extreme AMA women; as such, associations could not be evaluated. Statistically significant associations were observed in food-insecure Black women with GDM without concurrent polyhydramnios in those of optimal reproductive age (OR=0.469, 95% CI, 0.309–0.710, p