187 - Sustaining Food Insecurity Surveillance: Insights from a Decade of Clinical Cohort Data

Publication Number: 1176.187

Samuel O. Owolabi, University of Nebraska Medical Center, Omaha, NE, United States; Emily Major, Creighton University School of Medicine, Omaha, NE, United States; Colman I. Freel, University of Nebraska Medical Center, Omaha, NE, United States; Corrine Hanson, University of Nebraska Medical Center, Omaha, NE, United States; Ann L. Anderson Berry, University of Nebraska Medical Center, OMAHA, NE, United States

Background: Food insecurity (FI) impacts >2 billion people (~1/3 of world’s population). U.S. national estimates of FI have remained relatively stable (10%-14%). The stability of FI can obscure heterogeneity in specific populations—such as in pregnancy, where the nutritional requirements are raised and socioeconomic determinants of health can differ from the general population. To identify disparities hidden within national aggregate statistics, we examined the trend of FI within a clinical cohort of pregnant patients and assessed whether trends changed after 2020 (COVID-19 onset).

Objective: Compare cohort levels of FI to the most recent national benchmarks, identify sociodemographic predictors of FI, and determine associations between FI and adverse perinatal outcomes.

Design/Methods: Maternal-infant dyads (n=657) were recruited at a Midwestern academic medical center at the time of delivery (2015-2024). A validated food security status (FSS) questionnaire assessed FI among recruited participants. Annual prevalence of FI was calculated and standardized for maternal age, parity and income-poverty ratio. Logistic regression models assessed the association between calendar years and odds of FI. Logistic regression estimated predictors of FI and associations with perinatal outcomes. National FI benchmarks were assessed from publicly available USDA datasets for contextual comparison.

Results: Prevalence of FI was 16%. Among low-income families, black households had the highest prevalence at 30%. Annual odds of FI showed significant trends after 2020 (AOR per year = 1.9; 95% CI 1.1–3.1; p = < 0.01). Standardized prevalence rose from 15% in 2015 to 29% in 2024 in our cohort. National prevalence rose from 12% in 2015 to 14% in 2023 (most recent available data). Income–poverty ratio ≤ 1.5 (AOR 4.9; 95% CI 2.5–9.6) remained an independent predictor of FI. FI was associated with higher odds of NICU admission (AOR 2.2, p = < 0.01).

Conclusion(s): Our analysis reveals FI spiked during the COVID-19 pandemic and briefly declined after stimulus disbursement but has gradually risen since. FI is associated with perinatal complications and low income especially in marginalized groups. These findings highlight the importance of surveillance especially in vulnerable populations, and identify FSS as a responsive indicator of FI. Our findings suggest hospitals settings can serve as sentinel surveillance platforms for sustaining visibility on FI and its downstream health effects. Integrating routine FI screening into antenatal and postnatal care may help inform responsive equitable interventions tailored to where they are needed most.