Mental distress and food insecurity in pregnancy

Harmel, Betina; Höfelmann, Doroteia Aparecida

doi:10.1590/1413-81232022275.09832021

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FREE THEMES • Ciênc. saúde coletiva 27 (05) • May 2022 • https://doi.org/10.1590/1413-81232022275.09832021 copy

Mental distress and food insecurity in pregnancy

Sofrimento mental e insegurança alimentar na gestação

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Food insecurity is a source of daily stress, especially in women. The aim was to investigate the association between mental distress and food insecurity in pregnant women. Cross-sectional study with pregnant women from the public health service, regardless risk stratification, or gestational trimester in Colombo-PR, Brazil. Poisson regression models were progressively adjusted for exposure variables. Results: Among the participating pregnant women (N=513) the prevalence of mental distress was 50.1%; associated with mild food insecurity (PR 1.34, 95%CI 1.12; 1.61) and moderate/severe food insecurity (PR 1.70, 95%CI 1.33; 2.19). The variable that most changed the association between the outcome and mild food insecurity was income (-4.48%) and, for moderate/severe food insecurity, education (-7.60%). For mild and moderate/severe food insecurity, the greatest reduction occurred with socioeconomic variables 4.5% (PR 1.27, 95%CI 1.05; 1.53) and 8.0% (PR 1.50, 95% CI 1.17; 1.93), respectively. The association between food insecurity and mental distress was consistent, and increased with the degree of food insecurity, with a greater reduction for socioeconomic variables.

Key words:
Pregnancy; Mental health; Food and nutrition security; Cross-sectional studies

Variables		N	%
Demographic
Age group (years)
	≤19	80	15.6
	20-29	320	62.4
	≥30	113	22.0
Marital status
	Lives with a partner	417	81.3
	Lives without a partner	96	18.7
Self-declared color/race
	White/yellow	282	55.0
	Black/brown	231	45.0
Socioeconomic
Schooling (years of education)
	0-7	89	17.4
	8-10	191	37.2
	≥11	233	45.4
Household income per capita (Tertile)
	1^sttertile (BRL 0.00-475.00)	173	33.7
	2^ndtertile (BRL 476.00-750.00)	172	33.5
	3^rdtertile (BRL 751.00-3000.00)	168	32.8
Paid work
	No	302	58.9
	Yes	211	41.1
Health-related behaviors
Physical activity
	Sedentary	91	17.7
	Mild	234	45.6
	Moderate or intense	188	36.7
Smoking
	Didn’t smoke	472	92.0
	Smoked	41	8.0
Alcohol consumption in the last 12 months
	Did not consume	400	78.0
	Consumed	113	22.0
Obstetric
Number of pregnancies
	1	210	40.9
	2	165	32.2
	3	138	26.9
Planned pregnancy
	No	335	65.3
	Yes	178	34.7
Gestational trimester
	0-13 weeks	86	16.8
	14-26 weeks	174	33.9
	27 or more weeks	253	49.3
Food Insecurity
No Food Insecurity		284	55.4
Mild		196	38.2
Moderate/Severe		33	6.4
Mental Distress
No		256	49.9
Yes		257	50.1

Variables		N (%)	PR (95%CI)	P-value*
Demographic
Age group (years)				0.275
	≤19	45 (56.3)	1.00
	20-29	158 (49.4)	0.88 (0.70; 1.10)
	≥30	54 (47.8)	0.85 (0.65; 1.12)
Marital status				0.001
	Lives with a partner	196 (47.0)	1.00
	Lives without a partner	61 (63.5)	1.35 (1.13; 1.62)
Self-declared color/race				0.561
	White/yellow	138 (48.9)	55.0
	Black/brown	119 (51.5)	1.05 (0.89; 1.25)
Socioeconomic
Schooling (years of education)				0.001
	0-7	54 (60.7)	1.00
	8-10	104 (54.5)	0.90 (0.73; 1.11)
	≥11	99 (42.5)	0.70 (0.56; 0.88)
Household income per capita (Tertile)				0.002
	1^sttertile (BRL 0.00-475.00)	105 (60.7)	1.00
	2^ndtertile (BRL 476.00-750.00)	78 (45.4)	0.75 (0.61; 0.92)
	3^rdtertile (BRL 751.00-3000.00)	74 (44.1)	0.73 (0.59; 0.89)
Paid work				0.124
	No	160 (53.0)	1.00
	Yes	97 (46.0)	0.87 (0.72; 1.04)
Health-related behaviors
Physical activity				0.362
	Sedentary	43 (47.3)	1.00
	Mild	115 (49.2)	1.04 (0.81; 1.34)
	Moderate or intense	99 (52.7)	1.11 (0.86; 1.44)
Smoking				0.043
	Did not smoke	231 (48.9)	1.00
	Smoked	26 (63.4)	1.30 (1.00; 1.66)
Alcoholic beverages consumed in the last 12 months				0.004
	Did not consume	188 (47.0)	1.00
	Consumed	69 (61.0)	1.30 (1.08; 1.56)
Obstetric
Number of pregnancies				0.008
	1	99 (47.1)	1.00
	2	71 (43.0)	0.91 (0.73; 1.15)
	3	87 (63.0)	1.34 (1.10; 1.62)
Planned pregnancy				0.045
	No	179 (53.4)	1.00
	Yes	78 (43.8)	0.82 (0.68; 0.99)
Gestational trimester				0.006
	0-13 weeks	33 (38.4)	1.00
	14-26 weeks	83 (47.7)	1.24 (0.91; 1.69)
	27 or more weeks	141 (55.7)	1.45 (1.09; 1.94)
Food Insecurity				<0.001*
No Food Insecurity		121 (42.6)	1.00
Mild		112 (57.1)	1.34 (1.12; 1.61)
Moderate/Severe		24 (72.7)	1.71 (1.33; 2.19)

Variables	Mental distress	% PR change not adjusted**	Mental distress	% PR change not adjusted**	P-value*
Variables	Mild Insecurity PR (95%CI)	% PR change not adjusted**	Moderate/Severe Insecurity PR (95%CI)	% PR change not adjusted**	P-value*
Not adjusted	1.34 (1.12; 1.61)	-	1.71 (1.33; 2.19)	-	<0.001
Age range	1.34 (1.12; 1.61)	0	1.70 (1.33; 2.19)	-0.58	<0.001
Marital status	1.33 (1.11; 1.59)	-0.75	1.63 (1.28; 2.09)	-4.78	<0.001
Self-declared color/race	1.34 (1.12; 1.61)	0	1.70 (1.33; 2.18)	-0.58	<0.001
Education	1.31 (1.09; 1.57)	-2.24	1.58 (1.23; 2.04)	-7.60	<0.001
Household income per capita	1.28 (1.06; 1.54)	-4.48	1.65 (1.29; 2.11)	-3.51	<0.001
Paid work	1.34 (1.11; 1.60)	0	1.68 (1.31; 2.16)	-1.75	<0.001
Smoking	1.34 (1.12; 1.61)	0	1.70 (1.33; 2.18)	-0.58	<0.001
Alcohol consumption	1.31 (1.09; 1.57)	-2.24	1.67 (1.30; 2.14)	-2.34	<0.001
Physical activity	1.34 (1.11; 1.60)	0	1.70 (1.33; 2.18)	-0.58	<0.001
Number of pregnancies	1.32 (1.10; 1.58)	- 1.49	1.60 (1.24; 2.05)	-6.43	<0.001
Planned pregnancy	1.33 (1.11; 1.59)	-0.75	1.70 (1.33; 2.18)	-0.58	<0.001
Gestational trimester	1.33 (1.11; 1.59)	-0.75	1.70 (1.33; 2.17)	-0.58	<0.001

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[1] Collaborations

B Harmel participated in the concept, data gathering, analysis and interpretation of the results, drafting and critically reviewing the manuscript. DA Höfelmann contributed to study design, analysis, and interpretation of results, critically reviewing the manuscript. All the authors have approved the final version of the manuscript and are responsible for all its aspects, including the guarantee of its accuracy and integrity.