Food insecurity in a cohort of Jamaican women in the preconception and prenatal period

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However, food insecurity is a modifiable risk factor which can be addressed through nutritional interventions. Measuring maternal food insecurity during the course of pregnancy is an important indicator for determining the magnitude of the risk factor and developing interventions to address at risk women. We aimed to assess food insecurity during the immediate preconception period until the beginning of the third trimester of pregnancy and to investigate its relationship with birth anthropometry and other factors. Method Our data were derived from a cross-sectional survey of 200 pregnant women in Kingston, Jamaica who participated in a longitudinal cluster randomized clinical trial. Interviewer-administered questionnaires assessed socio-demographic factors and food insecurity was measured using the Food Insecurity Experience Scale at 30–32 weeks gestation to assess food insecurity during the previous 12 months. The birth anthropometry of the offspring was obtained from their health records. Analysis of variance was used to determine whether there was a difference in birthweight and birth length between levels of food insecurity Results Mild, moderate and severe food insecurity were reported in 5.6%, 22.2% and 52.5% of women respectively. Food insecurity had no significant effect on birth weight or length. Conclusion Moderate and severe food insecurity were highly prevalent in Jamaican women during the immediate preconception and prenatal period, underscoring the urgent need for public health strategies to address this. food insecurity pregnancy Jamaica Figures Figure 1 Background The ‘first 500 days of life’, from conception to 6 months of age, is a vulnerable period during which maternal prenatal nutrition health plays a vital role in an infant’s life ( 1 ). Adequate maternal intake of macronutrients and micronutrients is important for optimal fetal development and growth ( 2 ). Maternal preconception and prenatal nutritional status are often suboptimal in low- and middle- income countries (LMICs) ( 3 ). Underweight, stunting and suboptimal weight gain during pregnancy increase the risk of a poor pregnancy outcome ( 3 ). Pregnant women who are especially vulnerable to the negative impact of food insecurity (FI) ( 4 ) are likely to have even more adverse pregnancy outcome (fetal losses, fetal growth restriction, preterm delivery, early life undernutrition with subsequent poor cognitive development among the offspring) ( 3 ). The United Nations Food and Agricultural Organization (UNFAO) and the World Health Organization (WHO), in their 2018 report, define FI as the lack of secure access to sufficient, safe and nutritious food required for normal growth, development and an active healthy life ( 5 ). Using the Food Insecurity Experience Scale (FIES), they reported that the prevalence of FI worldwide had improved from 18.6% in 1990–1992 to 10.9% in 2014–2016, and from 14.7% to 5.5% in Latin America and the Caribbean during the same period ( 6 ). As a result of the COVID-19 pandemic, these estimates increased exponentially in 2020, with an increase in moderate or severe FI of approximately 320 million people, an increase equal to that of the previous five years combined ( 7 ). In 2020, approximately 2368 million people (30.4%) experienced moderate or severe FI globally ( 7 ). Six Caribbean countries participated in this 2020 global estimate (Dominican Republic, Grenada, Haiti, Jamaica, Saint Lucia, Saint Vincent and the Grenadines), where 71.3% experienced moderate or severe FI and 39.2% experienced severe food insecurity ( 7 ). In 2023, it was reported that 33% and 37% of respondents in Jamaica were severely and moderately food insecure respectively ( 8 ) which demonstrated a worsening in the state of food insecurity compared to previous years (26% and 36% respectively in February 2022) ( 8 ). FI prior to and during pregnancy, an understudied public health concern, has potential consequences for offspring, including low birthweight ( 9 – 12 ), stunting, preterm delivery, early life undernutrition and poor cognitive development ( 3 ). Birth anthropometry is a nutritional indicator of the intrauterine environment and the relationship between low birthweight and the increased risk of obesity, coronary heart disease and diabetes later in life is well documented ( 13 ). There is a commitment globally to improve maternal and child nutrition across countries through the 2030 Agenda for Sustainable Development Goals (SDG) and to meeting SDG 2.1, to end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round, by 2030 ( 14 ). FI is an economic and social measure of a lack of consistent access to nutritionally adequate and safe food and is an example of how a mother’s nutritional status may be compromised ( 15 ). Maternal nutritional status is a modifiable risk factor that can be evaluated, monitored, and improved upon. Despite the known importance of maternal nutrition, the prevalence and impact of food insecurity among Jamaican women in the preconception and prenatal period remains understudied. We aimed to describe food insecurity in a cohort of Jamaican women during the immediate preconception period until the beginning of the third trimester of pregnancy and to investigate its relationship with birth anthropometry, maternal socio-demographic status, parity and history of smoking during pregnancy. Methods Study design and study population Our data were derived from a cross-sectional survey involving 200 pregnant women from Kingston, Jamaica who were participating in a longitudinal cluster-randomized clinical trial (Clinical trial identifier NCT 04047888, Registration date with Clinical Trial Registry: August 6, 2019). This longitudinal study aimed to compare the impact of a maternal nutrition-based educational intervention on infant feeding on their offspring’s fat mass index at one year of age. For the study, baseline FIES was conducted for all participants prior to the intervention. The FIES scale is an open access scale developed by the Food and Agriculture Organization. The scale is licensed under a Creative Commons CC BY-NC-SA 3.0 International License https://openknowledge.fao.org/items/18cdbe53-7c7a-4fe4-aa65-9850d60ae257 Link to Deed https://creativecommons.org/licenses/by-nc-sa/3.0/deed.en Recruitment and study procedure The health centers were selected randomly in Kingston and Andrew. On antenatal clinic days, the research team visited the selected health centers, and all pregnant women were screened and asked to participate if they met the eligibility criteria. Our sample consisted of 200 women who completed interviewer-administered questionnaires at their baseline visit at 30-32 weeks of gestation between January 2019 and July 2023. Recruitment started prior to the COVID-19 pandemic and had to be paused until it was safe to resume. Questions were asked about demographics, socioeconomic status and a retrospective measure of household food insecurity status. Two women who did not complete the Food Insecurity Experience Scale (FIES) were excluded from the analyses. Birth anthropometries were available for the offspring of 181 women. Measures Food insecurity status Food insecurity was assessed using the standardized eight-item FIES developed by the UNFAO (14, 16). This was based on participants’ recall of their experience of food insecurity over the past 12 months. The FIES is designed to capture FI retrospectively over a 12 month period. When administered to our participants between 30-32 weeks gestation, it served to assess FI during 4 months prior to conception up until 32 weeks gestation. The possible responses for each question in the FIES include “No” scored as 0, “Yes” scored as 1 and “Don’t know” scored as DK. The participant was classified as food secure if she answered “No” to all 8 questions; mild food insecurity if answered "Yes” to questions 1, 2 or 3 ; moderate food insecurity if answered "Yes” to questions 4, 5 or 6 ; and, severe food insecurity if answered "Yes to questions 7 or 8 (17). Demographic and socioeconomic status We collected data on maternal age, highest level of education, employment status, category of job (if employed), marital status and smoking history during pregnancy (Supplementary material pg 2). Birth anthropometric variables Birth weight and length of the offspring were obtained from their Health Passport at their 1-month visit to the Research Unit. The sex of infants was also documented. Statistical analysis This sample size in this study was adequate to detect at least moderate food insecurity. With the average birth rate per year in Kingston and St. Andrew during that period of 6,526 and a pre-COVID hunger index of 13.9%, and 80% power, this yielded a sample size of 179 (18). Data analysis was performed using IBM SPSS version 28. Variables were described using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Preliminary checks were conducted using bivariate analyses to determine the associations between the independent variables and food insecurity (main outcome variable). Analysis of variance (ANOVA) and post hoc analyses using the Bonferroni test were used to determine if there was a difference in birth weight and birth length between levels of food security. Statistical significance was set at P < 0.05. Results Food insecurity and maternal characteristics The study sample consisted of 198 mother-infant pairs. Mild, moderate and severe FI was experienced by 5.6%, 22.2% and 52.5% respectively, of Jamaican women in the immediate preconception period and during pregnancy (Table 1). This table also shows the characteristics of the pregnant women. Their ages ranged from 18 to 43 years old. Most of the women (43.9%) were between 18 and 24 years old, 38.3% were between 25 and 34 years old and 17.7% were 35 years or older. Regarding schooling, most women (95.5%) studied up to high school or beyond. Most women (73.7%) were unemployed. Of those employed (26.2%), approximately half (n=23) were semi-skilled, one-quarter (n=15) unskilled, one-quarter skilled (n=13) and only one person was highly skilled. Just over half (59.1%) of women reported being married or living with a partner. One-third of women were nulliparous, 46.5% of women had one to two children, whereas 21.7% had three or more. Only 7.1% of women reported smoking during their pregnancy. Overall, 80.3% of pregnant women reported being food insecure in the previous year, with approximately half (52.5%) of the entire study population reporting severe food insecurity. Table 1 . Characteristics of 198 pregnant women at 30-32 weeks gestation All participants N % Maternal age (years) 18-24 87 43.9 25-34 76 38.3 ≥ 35 35 17.7 Highest level of education Less than high school 9 4.5 High school or greater 189 95.5 Employment status Unemployed 146 73.7 Employed 52 26.2 Marital status Unmarried 81 40.9 Married/living together 117 59.1 Parity 0 63 31.8 1-2 92 46.5 ≥3 43 21.7 Smoking history No 184 92.9 Yes 14 7.1 Food insecurity None 39 19.7 Mild 11 5.6 Moderate 44 22.2 Severe 104 52.5 The following are the Food Insecurity Experience Scale questions administered to the participant about during the last 12 months, if there was a time when: WORRIED, worried you would run out of food because of a lack of money or other resources; HEALTHY, you were unable to eat healthy and nutritious food because of a lack of money or other resources; FEWFOODS, you ate only a few kinds of foods because of a lack of money or other resources; SKIPPED, you had to skip a meal because there was not enough money or other resources to get food; ATELESS, you ate less than you thought you should because of a lack of money or other resources; RANOUT - you ran out of food because of a lack of money or other resources; HUNGRY - Hungry but did not eat because there was not enough money or other resources for food; WHOLEDAY - Went without eating for a whole day because of a lack of money or other resources. Figure 1 shows the proportion of pregnant women who answered the FIES questions affirmatively. The negative experience most often reported by our pregnant mothers in Jamaica was “eating only a few kinds of foods” (62.6%). Alarmingly 17.2% went a whole day without eating at some point in the 12 months prior to the survey. Bivariate analyses revealed no significant associations (p>0.05) between maternal age group, highest level of education, employment status, marital status, parity, smoking history during pregnancy and food insecurity. Food insecurity and birth anthropometry of offspring Table 2 shows the birth anthropometric results of the offspring. Data were available for 181 offspring. The average birth weight was 3.18kg, and the average birth length was 50cm. Table 3 shows the distribution of birth weight and length by the level of food insecurity. Low birthweight was recorded in 4.4% of offspring in this study. An Analysis of Variance (ANOVA) and post hoc Bonferroni analyses did not demonstrate any difference in birth weight or length between levels of food security. However, infants born to mothers with mild FI had a birthweight that tended to be lower than those who were food secure (p=0.06). Table 2 . Birth anthropometry of the offspring Females (n= 101) Mean ± SD Males (n=80) Mean ± SD Total Mean ± SD Birthweight (kg) 3.16 ±0.45 3.22 ± 0.48 3.18 ± 0.46 Birth length (cm) 49.79 ± 2.92 50.24 ± 2.73 50 ± 2.84 Table 3 . Distribution of birth weight and birth length by level of food insecurity Food secure (n= 34) (Mean ± SD) Mild FI (n= 11) (Mean ± SD) Moderate FI (n= 41) (Mean ± SD) Severe FI (n= 93) (Mean ± SD) Birthweight (kg) 3.34 ± 0.41 2.92 ± 0.41 3.16 ± 0.50 3.17 ± 0.46 Birth length (cm) 50.65 ± 2.69 48.86 ± 1.76 49.18 ± 2.66 50.26 ± 2.99 Food insecurity and the COVID-19 pandemic We examined food insecurity in our participants pre-COVID-19 and during and after COVID-19 after condensing food insecurity groups into two categories: food secure and mild food insecure women as one group and moderate and severe food insecure women as another. Between these time periods, FI increased in the ‘moderate and severe FI group’ (from 71.4% to 76.3%), although not statistically significant (results not shown). Discussion In our study, we found that during the period 2019–2023, 22.2% and 52.5% of our pregnant women in their third trimester reported moderate and severe FI respectively over the previous 12 months. There are limited studies in Latin America and the Caribbean (LAC) and none to our knowledge in Jamaica, exploring FI during pregnancy. A systematic review conducted reviewing publications up to February 2024 showed the prevalence of FI during pregnancy ranging from 28.2% in Brazil to 64.9% in Haiti ( 19 ). Data collection during pregnancy was carried out during the prenatal period, at birth or during the postnatal period and the recall period for measuring FI ranged from within the last 30days, 3 months, 12 months or throughout pregnancy ( 19 ). The FIES was not used as the FI assessment tool in any of the studies ( 19 ). The FIES is a validated tool developed and validated for international use. It measures people’s access to food and is well-aligned with SDG Target 2.1 ( 16 ). The “Prevalence of moderate or severe food insecurity in the population based on the FIES” was elected as the SDG indicator 2.1.2. to monitor the 2030 Agenda ( 16 ). From the “Caribbean COVID-19 Food Security and Livelihoods Impact Survey,” in 2023, with the use of the FIES methodology, as was used in our study, 37% and 33% of Jamaicans reported moderate and severe FI, respectively ( 8 ). This demonstrates an alarmingly higher prevalence of severe FI in our population than in the general population. When examining the magnitude of FI in accordance with the Sustainable Development Goal indicator 2.1.2 – “prevalence of moderate or severe FI in the population based on the FIES” ( 14 ), 74.7% of our participants reported moderate or severe FI in the past 12 months. This prevalence was greater than that for the general population in Jamaica and the Caribbean in 2022 (58% and 48% respectively) ( 20 ) and similar to that of the general Jamaican population in 2023 (70%) ( 8 ) as well as among pregnant women aged 18–49 years in Nigeria in 2021 (75%) ( 21 ). In the United States, 10% of pregnant and postpartum women lived in food-insecure households between 2019 and 2021 ( 22 ) whereas 34.8% of pregnant Brazilian women were FI( 7 ) in 2015 ( 6 ). The prevalence of food insecurity in the USA, Nigeria and Brazilian populations was lower than that in our study. One factor could be the difference in the scale used to assess food security; the 10-item USDA Family Food Security questionnaire was used in the former study ( 22 ) and the Brazilian Scale of Food Insecurity in the latter ( 6 ). Households are more likely to experience FI if they include single women with children, women with higher parity (5 or more), urban dwellers, large household size, lower socio-economic group and households with an adult smoker ( 21 , 23 ). However, the study did not detect any association between parity, highest level of education, employment status, marital status, smoking history during pregnancy and FI among women in our cohort. Food security during pregnancy is linked to adverse maternal and neonatal outcomes ( 21 ). Specifically, during the third trimester of pregnancy, during which most fetal growth occurs ( 2 , 24 ), FI may affect fetal growth and result in a low birth weight infant ( 25 ). Our study showed that infants born to mothers with mild FI had a birthweight that tended to be lower than those who were food secure. The birth weight and length of offspring of mothers with moderate or severe FI were not different from those of mothers with food security. We hypothesized that moderate or severe FI may not have been long standing and persistent, as such, would not have an impact on fetal growth. However, mild FI may have been chronic, and as such, the effect on fetal growth would be more apparent. Limited studies are available on the impact of FI on pregnancy and neonatal outcomes. DaSilva et.al. showed that mainly among low- and middle-income countries, maternal prenatal FI increases the risk of low birthweight offspring ( 26 ). The Barker hypothesis notes that low birth weight significantly increases one’s risk for future adult disease ( 27 ). Findings from the Dutch famine birth cohort study, which served as a natural experiment to study the long-term effects of prenatal exposure to malnutrition on health in later life ( 28 ), support the fetal origins hypothesis. However, they showed that the effects of maternal undernutrition during gestation depend on its timing during gestation ( 28 ). Undernutrition during the first trimester, possibly through epigenetic changes, results in fetal adaptations that predispose them to coronary heart disease, dyslipidemia, cancers, diabetes and obesity in later life ( 28 ). Interestingly, this may occur without affecting fetal size at birth ( 28 ). Pregnant women exposed to the Dutch famine in early gestation had offspring who were 1.3 times more likely to be overweight or obese at 19 years ( 29 ). Our study examined FI during the prenatal period and early pregnancy. A cohort follow-up study of the offspring would be prudent to monitor “adult health risks” two decades from now. During the COVID-19 pandemic, many households experienced an increase in the FI ( 10 ). Over the 2020–2023 period, Jamaica was the country with the second highest prevalence (54.4%) of FI in the LAC region ( 19 ). Our data collection started before COVID-19 and continued during and after the pandemic. The absence of a significant change in the prevalence of FI between these periods may be attributed to other factors. The cross-sectional design of the study limits the ability to infer causality between FI and birth outcomes. A longitudinal design, capturing FI status before, during and after pregnancy to assess potential varying impacts on birth outcomes would have been better as food security may have changed throughout the pregnancy. A larger sample size may have been more robust in determining whether there was an association between FI status and birth anthropometry. These data cannot be generalized to the entire country, as the majority of the participants were urban dwellers. The findings of this study, however, represent important contributions to the literature on the prevalence of FI in Jamaican women in the immediate preconception period and during pregnancy and provide justification for further research into the possible impact of FI in pregnancy. Conclusions In summary, moderate and severe food insecurity was highly prevalent in Jamaican women during the immediate preconception and prenatal period. Therefore, mild FI in this population cannot be ignored. This underscores the urgent need for a national survey including a more diverse geographic sampling that encompasses both urban and rural settings to better understand the dynamics between these populations. Subsequent social intervention and clinical and public health strategies to address all FI levels among pregnant women in our country is warranted. This will, in turn, improve health outcomes for the offspring and align with the 2023 Sustainable Development Goals (SDG), especially towards meeting SDG 2.1 ( 14 ). We advocate for the implementation of universal FI screening of pregnant women at their first antenatal visit, with referrals to available community-based resources as needed. Abbreviations FI: food insecurity FIES: Food Insecurity Experience Scale LMIC: low- and middle-income countries SDG: Sustainable Development Goals UNFAO: United Nations Food and Agricultural Organization WHO: World Health Organization Declarations Ethics approval and consent to participate Ethics approval was obtained from the Mona Campus Research Ethics Committee (ECP 115, 17/18) and the Advisory Panel on Ethics and Medico-legal Affairs (Reference # 2018/05). This research study was designed and implemented in accordance with the Declaration of Helsinki’s principles on studies involving human subjects. Written informed consent was obtained from all patients. Consent for publication Not applicable Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding The International Atomic Energy Agency assisted in the study design and funded the study. They had no restrictions regarding publications. Authors’ contributions The authors’ contributions were as follows – CRT, AVB, NOMY, and GMG designed research; CRT, OSB, JKF, TMD and DJT conducted research; CRT and GMG analyzed data and wrote the article; CRT had primary responsibility for final content. All authors read and approved the final manuscript. Acknowledgements Not applicable Footnotes Not applicable References Mason JB, Shrimpton R, Saldanha LS, Ramakrishnan U, Victora CG, Girard AW, et al. The first 500 days of life: policies to support maternal nutrition. Glob Health Action. 2014;7:23623. Pitkin RM. 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Overweight and obesity at age 19 after pre-natal famine exposure. Int J Obes (Lond). 2021;45(8):1668-76. Additional Declarations No competing interests reported. Supplementary Files SupplementaryfileDemographicandsocioeconomicstatusquestionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Editor invited by journal 25 Mar, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 23 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Indies","correspondingAuthor":false,"prefix":"","firstName":"Janeila","middleName":"K","lastName":"Frater-Williams","suffix":""},{"id":625099200,"identity":"d44be859-507a-45a5-8abd-c10218efb726","order_by":5,"name":"Tameka M Duncan-Baker","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Tameka","middleName":"M","lastName":"Duncan-Baker","suffix":""},{"id":625099202,"identity":"e95ed3fa-fc56-40d9-a6b7-f3393929a36f","order_by":6,"name":"Daniel J Thomas","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"J","lastName":"Thomas","suffix":""},{"id":625099203,"identity":"0a3d271f-ffa2-4eda-9877-cd1b33faeca3","order_by":7,"name":"Georgiana M Gordon-Strachan","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Georgiana","middleName":"M","lastName":"Gordon-Strachan","suffix":""}],"badges":[],"createdAt":"2026-03-13 20:23:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9117914/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9117914/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107706540,"identity":"de98907b-e5ac-48ec-9be0-7ab2c7ac1326","added_by":"auto","created_at":"2026-04-24 09:18:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37703,"visible":true,"origin":"","legend":"\u003cp\u003eAffirmative responses to the Food Insecurity Experience Scale by 198 pregnant women at 30-32 weeks gestation\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9117914/v1/e3eebb3b896e04c8a03ecc2e.png"},{"id":107710361,"identity":"5c908cc8-63be-4d00-b94c-8c2ec34c6f43","added_by":"auto","created_at":"2026-04-24 09:40:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":313909,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9117914/v1/e6fe60ff-269c-4f53-9801-de884d96bef7.pdf"},{"id":107572874,"identity":"70e51c5d-430f-43e6-bd86-1dddf8376693","added_by":"auto","created_at":"2026-04-22 19:06:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23017,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryfileDemographicandsocioeconomicstatusquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-9117914/v1/ac495f6d277995f94c550e52.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Food insecurity in a cohort of Jamaican women in the preconception and prenatal period","fulltext":[{"header":"Background","content":"\u003cp\u003eThe \u0026lsquo;first 500 days of life\u0026rsquo;, from conception to 6 months of age, is a vulnerable period during which maternal prenatal nutrition health plays a vital role in an infant\u0026rsquo;s life (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Adequate maternal intake of macronutrients and micronutrients is important for optimal fetal development and growth (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Maternal preconception and prenatal nutritional status are often suboptimal in low- and middle- income countries (LMICs) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Underweight, stunting and suboptimal weight gain during pregnancy increase the risk of a poor pregnancy outcome (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Pregnant women who are especially vulnerable to the negative impact of food insecurity (FI) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) are likely to have even more adverse pregnancy outcome (fetal losses, fetal growth restriction, preterm delivery, early life undernutrition with subsequent poor cognitive development among the offspring) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe United Nations Food and Agricultural Organization (UNFAO) and the World Health Organization (WHO), in their 2018 report, define FI as the lack of secure access to sufficient, safe and nutritious food required for normal growth, development and an active healthy life (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Using the Food Insecurity Experience Scale (FIES), they reported that the prevalence of FI worldwide had improved from 18.6% in 1990\u0026ndash;1992 to 10.9% in 2014\u0026ndash;2016, and from 14.7% to 5.5% in Latin America and the Caribbean during the same period (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs a result of the COVID-19 pandemic, these estimates increased exponentially in 2020, with an increase in moderate or severe FI of approximately 320\u0026nbsp;million people, an increase equal to that of the previous five years combined (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In 2020, approximately 2368\u0026nbsp;million people (30.4%) experienced moderate or severe FI globally (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Six Caribbean countries participated in this 2020 global estimate (Dominican Republic, Grenada, Haiti, Jamaica, Saint Lucia, Saint Vincent and the Grenadines), where 71.3% experienced moderate or severe FI and 39.2% experienced severe food insecurity (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In 2023, it was reported that 33% and 37% of respondents in Jamaica were severely and moderately food insecure respectively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) which demonstrated a worsening in the state of food insecurity compared to previous years (26% and 36% respectively in February 2022) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFI prior to and during pregnancy, an understudied public health concern, has potential consequences for offspring, including low birthweight (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), stunting, preterm delivery, early life undernutrition and poor cognitive development (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Birth anthropometry is a nutritional indicator of the intrauterine environment and the relationship between low birthweight and the increased risk of obesity, coronary heart disease and diabetes later in life is well documented (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a commitment globally to improve maternal and child nutrition across countries through the 2030 Agenda for Sustainable Development Goals (SDG) and to meeting SDG 2.1, to end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round, by 2030 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). FI is an economic and social measure of a lack of consistent access to nutritionally adequate and safe food and is an example of how a mother\u0026rsquo;s nutritional status may be compromised (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Maternal nutritional status is a modifiable risk factor that can be evaluated, monitored, and improved upon. Despite the known importance of maternal nutrition, the prevalence and impact of food insecurity among Jamaican women in the preconception and prenatal period remains understudied. We aimed to describe food insecurity in a cohort of Jamaican women during the immediate preconception period until the beginning of the third trimester of pregnancy and to investigate its relationship with birth anthropometry, maternal socio-demographic status, parity and history of smoking during pregnancy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur data were derived from a cross-sectional survey involving 200 pregnant women from Kingston, Jamaica who were participating in a longitudinal cluster-randomized clinical trial (Clinical trial identifier NCT 04047888, Registration date with Clinical Trial Registry: August 6, 2019). \u0026nbsp;This longitudinal study aimed to compare the impact of a maternal nutrition-based educational intervention on infant feeding on their offspring\u0026rsquo;s fat mass index at one year of age. For the study, baseline FIES was conducted for all participants prior to the intervention. The FIES scale is an open access scale developed by the Food and Agriculture Organization. \u0026nbsp; The scale is licensed under a Creative Commons \u003cstrong\u003eCC BY-NC-SA 3.0 International License\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ehttps://openknowledge.fao.org/items/18cdbe53-7c7a-4fe4-aa65-9850d60ae257\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLink to Deed\u003c/p\u003e\n\u003cp\u003ehttps://creativecommons.org/licenses/by-nc-sa/3.0/deed.en\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment and study procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe health centers were selected randomly in Kingston and Andrew. On antenatal clinic days, the research team visited the selected health centers, and all pregnant women were screened and asked to participate if they met the eligibility criteria. Our sample consisted of 200 women who completed interviewer-administered questionnaires at their baseline visit at 30-32 weeks of gestation between January 2019 and July 2023. \u0026nbsp;Recruitment started prior to the COVID-19 pandemic and had to be paused until it was safe to resume. Questions were asked about demographics, socioeconomic status and a retrospective measure of household food insecurity status. Two women who did not complete the Food Insecurity Experience Scale (FIES) were excluded from the analyses. Birth anthropometries were available for the offspring of 181 women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFood insecurity status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFood insecurity was assessed using the standardized eight-item FIES developed by the UNFAO (14, 16). This was based on participants\u0026rsquo; recall of their experience of food insecurity over the past 12 months. The FIES is designed to capture FI retrospectively over a 12 month period. When administered to our participants between 30-32 weeks gestation, it served to assess FI during 4 months prior to conception up until 32 weeks gestation. The possible responses for each question in the FIES include \u0026ldquo;No\u0026rdquo; scored as 0, \u0026ldquo;Yes\u0026rdquo; scored as 1 and \u0026ldquo;Don\u0026rsquo;t know\u0026rdquo; scored as DK. The participant was classified as food secure if she answered \u0026ldquo;No\u0026rdquo; to all 8 questions; mild food insecurity if answered \u0026quot;Yes\u0026rdquo; to questions 1, 2 or 3 ; moderate food insecurity if answered \u0026quot;Yes\u0026rdquo; to questions 4, 5 or 6 ; and, severe food insecurity if answered \u0026quot;Yes to questions 7 or 8 (17).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic and socioeconomic status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected data on maternal age, highest level of education, employment status, category of job (if employed), marital status and smoking history during pregnancy (Supplementary material pg 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBirth anthropometric variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBirth weight and length of the offspring were obtained from their Health Passport at their 1-month visit to the Research Unit. The sex of infants was also documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis sample size in this study was adequate to detect at least moderate food insecurity. With the average birth rate per year in Kingston and St. Andrew during that period of 6,526 and a pre-COVID hunger index of 13.9%, and 80% power, this \u0026nbsp;yielded a sample size of 179 (18). Data analysis was performed using IBM SPSS version 28. Variables were described using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Preliminary checks were conducted using bivariate analyses to determine the associations between the independent variables and food insecurity (main outcome variable). Analysis of variance (ANOVA) and post hoc analyses using the Bonferroni test were used to determine if there was a difference in birth weight and birth length between levels of food security. Statistical significance was set at P \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eFood insecurity and maternal characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sample consisted of 198 mother-infant pairs. Mild, moderate and severe FI was experienced by 5.6%, 22.2% and 52.5% respectively, of Jamaican women in the immediate preconception period and during pregnancy\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Table 1).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis table also shows the characteristics of the pregnant women. Their ages ranged from 18 to 43 years old. Most of the women (43.9%) were between 18 and 24 years old, 38.3% were between 25 and 34 years old and 17.7% were 35 years or older. Regarding schooling, most women (95.5%) studied up to high school or beyond.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost women (73.7%) were unemployed. Of those employed (26.2%), approximately half (n=23) were semi-skilled, one-quarter (n=15) unskilled, one-quarter skilled (n=13) and only one person was highly skilled. Just over half (59.1%) of women reported being married or living with a partner. One-third of women were nulliparous, 46.5% of women had one to two children, whereas 21.7% had three or more. Only 7.1% of women reported smoking during their pregnancy. Overall, 80.3% of pregnant women reported being food insecure in the previous year, with approximately half (52.5%) of the entire study population reporting severe food insecurity. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Characteristics of 198 pregnant women at 30-32 weeks gestation\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eMaternal age (years)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026ge; 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eHighest level of education\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHigh school or greater\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e95.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eEmployment status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eMarital status\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMarried/living together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eParity\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eSmoking history\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eFood insecurity\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe following are the Food Insecurity Experience Scale questions administered to the participant about during the last 12 months, if there was a time when: WORRIED, worried you would run out of food because of a lack of money or other resources; HEALTHY, you were unable to eat healthy and nutritious food because of a lack of money or other resources; FEWFOODS, you ate only a few kinds of foods because of a lack of money or other resources; SKIPPED, you had to skip a meal because there was not enough money or other resources to get food; ATELESS, you ate less than you thought you should because of a lack of money or other resources; RANOUT - you ran out of food because of a lack of money or other resources; HUNGRY - Hungry but did not eat because there was not enough money or other resources for food; WHOLEDAY - Went without eating for a whole day because of a lack of money or other resources.\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the proportion of pregnant women who answered the FIES questions affirmatively. The negative experience most often reported by our pregnant mothers in Jamaica was \u0026ldquo;eating only a few kinds of foods\u0026rdquo; (62.6%). Alarmingly 17.2% went a whole day without eating at some point in the 12 months prior to the survey.\u003c/p\u003e\n\u003cp\u003eBivariate analyses revealed no significant associations (p\u0026gt;0.05) between maternal age group, highest level of education, employment status, marital status, parity, smoking history during pregnancy and food insecurity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFood insecurity and birth anthropometry of offspring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the birth anthropometric results of the offspring. Data were available for 181 offspring. The average birth weight was 3.18kg, and the average birth length was 50cm. Table 3 shows the distribution of birth weight and length by the level of food insecurity. Low birthweight was recorded in 4.4% of offspring in this study. An Analysis of Variance (ANOVA) and post hoc Bonferroni analyses did not demonstrate any difference in birth weight or length between levels of food security. However, infants born to mothers with mild FI had a birthweight that tended to be lower than those who were food secure (p=0.06).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Birth anthropometry of the offspring\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemales (n= 101)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMales (n=80)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eBirthweight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3.16 \u0026plusmn;0.45\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.22 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3.18 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eBirth length (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e49.79 \u0026plusmn; 2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e50.24 \u0026plusmn; 2.73\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e50 \u0026plusmn; 2.84\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Distribution of birth weight and birth length by level of food insecurity\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFood secure (n= 34)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild FI (n= 11)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate FI (n= 41)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere FI (n= 93)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBirthweight (kg)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e3.34 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2.92 \u0026plusmn; 0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;3.16 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.17 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eBirth length (cm)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e50.65 \u0026plusmn; 2.69\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e48.86 \u0026plusmn; 1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e49.18 \u0026plusmn; 2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e50.26 \u0026plusmn; 2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFood insecurity and the COVID-19 pandemic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe examined food insecurity in our participants pre-COVID-19 and during and after COVID-19 after condensing food insecurity groups into two categories: food secure and mild food insecure women as one group and moderate and severe food insecure women as another. Between these time periods, FI increased in the \u0026lsquo;moderate and severe FI group\u0026rsquo; (from 71.4% to 76.3%), although not statistically significant (results not shown).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we found that during the period 2019\u0026ndash;2023, 22.2% and 52.5% of our pregnant women in their third trimester reported moderate and severe FI respectively over the previous 12 months. There are limited studies in Latin America and the Caribbean (LAC) and none to our knowledge in Jamaica, exploring FI during pregnancy. A systematic review conducted reviewing publications up to February 2024 showed the prevalence of FI during pregnancy ranging from 28.2% in Brazil to 64.9% in Haiti (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Data collection during pregnancy was carried out during the prenatal period, at birth or during the postnatal period and the recall period for measuring FI ranged from within the last 30days, 3 months, 12 months or throughout pregnancy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The FIES was not used as the FI assessment tool in any of the studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe FIES is a validated tool developed and validated for international use. It measures people\u0026rsquo;s access to food and is well-aligned with SDG Target 2.1 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The \u0026ldquo;Prevalence of moderate or severe food insecurity in the population based on the FIES\u0026rdquo; was elected as the SDG indicator 2.1.2. to monitor the 2030 Agenda (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom the \u0026ldquo;Caribbean COVID-19 Food Security and Livelihoods Impact Survey,\u0026rdquo; in 2023, with the use of the FIES methodology, as was used in our study, 37% and 33% of Jamaicans reported moderate and severe FI, respectively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This demonstrates an alarmingly higher prevalence of severe FI in our population than in the general population.\u003c/p\u003e \u003cp\u003eWhen examining the magnitude of FI in accordance with the Sustainable Development Goal indicator 2.1.2 \u0026ndash; \u0026ldquo;prevalence of moderate or severe FI in the population based on the FIES\u0026rdquo; (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), 74.7% of our participants reported moderate or severe FI in the past 12 months. This prevalence was greater than that for the general population in Jamaica and the Caribbean in 2022 (58% and 48% respectively) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and similar to that of the general Jamaican population in 2023 (70%) (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) as well as among pregnant women aged 18\u0026ndash;49 years in Nigeria in 2021 (75%) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In the United States, 10% of pregnant and postpartum women lived in food-insecure households between 2019 and 2021 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) whereas 34.8% of pregnant Brazilian women were FI(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) in 2015 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The prevalence of food insecurity in the USA, Nigeria and Brazilian populations was lower than that in our study. One factor could be the difference in the scale used to assess food security; the 10-item USDA Family Food Security questionnaire was used in the former study (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and the Brazilian Scale of Food Insecurity in the latter (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHouseholds are more likely to experience FI if they include single women with children, women with higher parity (5 or more), urban dwellers, large household size, lower socio-economic group and households with an adult smoker (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, the study did not detect any association between parity, highest level of education, employment status, marital status, smoking history during pregnancy and FI among women in our cohort.\u003c/p\u003e \u003cp\u003eFood security during pregnancy is linked to adverse maternal and neonatal outcomes (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Specifically, during the third trimester of pregnancy, during which most fetal growth occurs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), FI may affect fetal growth and result in a low birth weight infant (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our study showed that infants born to mothers with mild FI had a birthweight that tended to be lower than those who were food secure. The birth weight and length of offspring of mothers with moderate or severe FI were not different from those of mothers with food security. We hypothesized that moderate or severe FI may not have been long standing and persistent, as such, would not have an impact on fetal growth. However, mild FI may have been chronic, and as such, the effect on fetal growth would be more apparent.\u003c/p\u003e \u003cp\u003eLimited studies are available on the impact of FI on pregnancy and neonatal outcomes. DaSilva \u003cem\u003eet.al.\u003c/em\u003e showed that mainly among low- and middle-income countries, maternal prenatal FI increases the risk of low birthweight offspring (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The Barker hypothesis notes that low birth weight significantly increases one\u0026rsquo;s risk for future adult disease (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Findings from the Dutch famine birth cohort study, which served as a natural experiment to study the long-term effects of prenatal exposure to malnutrition on health in later life (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), support the fetal origins hypothesis. However, they showed that the effects of maternal undernutrition during gestation depend on its timing during gestation (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Undernutrition during the first trimester, possibly through epigenetic changes, results in fetal adaptations that predispose them to coronary heart disease, dyslipidemia, cancers, diabetes and obesity in later life (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Interestingly, this may occur without affecting fetal size at birth (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Pregnant women exposed to the Dutch famine in early gestation had offspring who were 1.3 times more likely to be overweight or obese at 19 years (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Our study examined FI during the prenatal period and early pregnancy. A cohort follow-up study of the offspring would be prudent to monitor \u0026ldquo;adult health risks\u0026rdquo; two decades from now.\u003c/p\u003e \u003cp\u003eDuring the COVID-19 pandemic, many households experienced an increase in the FI (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Over the 2020\u0026ndash;2023 period, Jamaica was the country with the second highest prevalence (54.4%) of FI in the LAC region (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Our data collection started before COVID-19 and continued during and after the pandemic. The absence of a significant change in the prevalence of FI between these periods may be attributed to other factors.\u003c/p\u003e \u003cp\u003eThe cross-sectional design of the study limits the ability to infer causality between FI and birth outcomes. A longitudinal design, capturing FI status before, during and after pregnancy to assess potential varying impacts on birth outcomes would have been better as food security may have changed throughout the pregnancy. A larger sample size may have been more robust in determining whether there was an association between FI status and birth anthropometry. These data cannot be generalized to the entire country, as the majority of the participants were urban dwellers. The findings of this study, however, represent important contributions to the literature on the prevalence of FI in Jamaican women in the immediate preconception period and during pregnancy and provide justification for further research into the possible impact of FI in pregnancy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, moderate and severe food insecurity was highly prevalent in Jamaican women during the immediate preconception and prenatal period. Therefore, mild FI in this population cannot be ignored. This underscores the urgent need for a national survey including a more diverse geographic sampling that encompasses both urban and rural settings to better understand the dynamics between these populations. Subsequent social intervention and clinical and public health strategies to address all FI levels among pregnant women in our country is warranted. This will, in turn, improve health outcomes for the offspring and align with the 2023 Sustainable Development Goals (SDG), especially towards meeting SDG 2.1 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). We advocate for the implementation of universal FI screening of pregnant women at their first antenatal visit, with referrals to available community-based resources as needed.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFI: food insecurity\u003c/p\u003e\n\u003cp\u003eFIES: Food Insecurity Experience Scale\u003c/p\u003e\n\u003cp\u003eLMIC: low- and middle-income countries\u003c/p\u003e\n\u003cp\u003eSDG: Sustainable Development Goals\u003c/p\u003e\n\u003cp\u003eUNFAO: United Nations Food and Agricultural Organization\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Mona Campus Research Ethics Committee (ECP 115, 17/18) and the Advisory Panel on Ethics and Medico-legal Affairs (Reference # 2018/05). This research study was designed and implemented in accordance with the Declaration of Helsinki\u0026rsquo;s principles on studies involving human subjects. Written informed consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe International Atomic Energy Agency assisted in the study design and funded the study. They had no restrictions regarding publications.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eThe authors\u0026rsquo; contributions were as follows \u0026ndash; CRT, AVB, NOMY, and GMG designed research; CRT, OSB, JKF, TMD and DJT conducted research; CRT and GMG analyzed data and wrote the article; CRT had primary responsibility for final content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFootnotes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMason JB, Shrimpton R, Saldanha LS, Ramakrishnan U, Victora CG, Girard AW, et al. The first 500 days of life: policies to support maternal nutrition. Glob Health Action. 2014;7:23623.\u003c/li\u003e\n\u003cli\u003ePitkin RM. 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Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers. Curr Nutr Rep. 2022;11(3):486-99.\u003c/li\u003e\n\u003cli\u003eDe Silva DA, Thoma ME, Anderson EA, Kim J. Infant Sex-Specific Associations between Prenatal Food Insecurity and Low Birthweight: A Multistate Analysis. J Nutr. 2022;152(6):1538-48.\u003c/li\u003e\n\u003cli\u003eCalkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care. 2011;41(6):158-76.\u003c/li\u003e\n\u003cli\u003eRoseboom T, de Rooij S, Painter R. The Dutch famine and its long-term consequences for adult health. Early Hum Dev. 2006;82(8):485-91.\u003c/li\u003e\n\u003cli\u003eLumey LH, Ekamper P, Bijwaard G, Conti G, van Poppel F. Overweight and obesity at age 19 after pre-natal famine exposure. Int J Obes (Lond). 2021;45(8):1668-76. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"food insecurity, pregnancy, Jamaica","lastPublishedDoi":"10.21203/rs.3.rs-9117914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9117914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFood insecurity in women during the preconception and prenatal period may result in poor health outcomes for the offspring, including low birth weight, stunting, preterm delivery, early life undernutrition and poor cognitive development. However, food insecurity is a modifiable risk factor which can be addressed through nutritional interventions. Measuring maternal food insecurity during the course of pregnancy is an important indicator for determining the magnitude of the risk factor and developing interventions to address at risk women. We aimed to assess food insecurity during the immediate preconception period until the beginning of the third trimester of pregnancy and to investigate its relationship with birth anthropometry and other factors.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eOur data were derived from a cross-sectional survey of 200 pregnant women in Kingston, Jamaica who participated in a longitudinal cluster randomized clinical trial. Interviewer-administered questionnaires assessed socio-demographic factors and food insecurity was measured using the Food Insecurity Experience Scale at 30\u0026ndash;32 weeks gestation to assess food insecurity during the previous 12 months. The birth anthropometry of the offspring was obtained from their health records. Analysis of variance was used to determine whether there was a difference in birthweight and birth length between levels of food insecurity\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMild, moderate and severe food insecurity were reported in 5.6%, 22.2% and 52.5% of women respectively. Food insecurity had no significant effect on birth weight or length.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eModerate and severe food insecurity were highly prevalent in Jamaican women during the immediate preconception and prenatal period, underscoring the urgent need for public health strategies to address this.\u003c/p\u003e","manuscriptTitle":"Food insecurity in a cohort of Jamaican women in the preconception and prenatal period","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 19:06:44","doi":"10.21203/rs.3.rs-9117914/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-17T15:42:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13463097089696318194784913313507158994","date":"2026-04-15T14:21:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T09:18:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T13:06:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-25T14:08:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T18:33:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-23T18:28:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"756767c6-a794-4f38-add4-f0ef51da223d","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T19:06:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 19:06:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9117914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9117914","identity":"rs-9117914","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}