Association between food environments and fetal growth in pregnant Brazilian women

Introduction Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. Design This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and municipal data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 th and 90 th percentile), SGA (90 th percentile), and low birth weight <2,500g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest. Results We analyzed 2,632,314 live births in Brazil in 2016. Following due adjustment, it was observed that women from municipalities in which there was a limited supply of in natura foods presented a higher chance of a SGA [OR 2nd tertile 1.06 (1.05-1.07)] and LBW [OR 2nd tertile 1.11(1.09-1.12)] newborn. On the other hand, municipalities in which there was a greater supply of ultra-processed foods presented higher chances for a SGA [OR 3rd tertile 1.04 (1.02-1.06)] and LBW [OR 2nd tertile 1.13 (1.11-1.16)] newborn. Stratification showed that Black and Mixed/Brown women were associated with SGA [OR 3rd tertile 1.09 (1.01-1.18)] and [OR 3rdtertile 1.06 (1.04-1.09)], respectively, and mixed-race women were also associated with LBW [OR 3rd tertile 1.17 (1.14-1.20)], while indigenous women were associated with LGA [OR 3rd tertile 1.20(1.01-1.45)]. Conclusions Living in areas with limited access to healthy foods was associated with an increased chance of SGA and low weight newborns, especially between Black and Mixed/Brown women. Initiatives focused on minimizing the effects of these food environments, and which aim to reduce social inequalities, are urgently required in the Brazilian context.