The relationship between antenatal food insecurity, maternal depression and birthweight and stunting: results from the National Income Dynamics Study (NIDS)

Abstract

Background: Maternal food insecurity is an important social determinant of health and has been associated with adverse birth and pregnancy outcomes as well as depressive symptoms. Pregnant women and new mothers are vulnerable to both food insecurity and depression. This thesis investigated the relationships between maternal food insecurity, depressive symptoms and low birthweight and stunting using nationally representative longitudinal data from the National Income Dynamics Study (NIDS). In addition, the thesis also examined the association between various food security indicators and adult and child anthropometry. Methods: The NIDS data included three experiential indicators of food security (adult and child hunger in the household in the past twelve months and household food sufficiency in the past 12 months) as well as household dietary diversity in the past thirty days and household food expenditure in the past thirty days. Three of the included studies utilised NIDS data. a) Chapter 4 was a scoping review that examined dietary diversity and maternal depression. b) Chapter 5 gives a broad overview by using cross-sectional data from wave 1 to examine food security indicators in relation to adult and child anthropometry. c) Chapter 6 used maternal data from Wave 1 of NIDS and child data from wave 3 of NIDS to longitudinally examine maternal depression and food insecurity during the periconceptional and antenatal period in relation to a continuous measure of birthweight and children’s height-for-age scores. In this vein, Chapter 6 employs different statistical measures to achieve longitudinal perspectives. d) Chapter 7 used the same dataset as Chapter 6 to examine various maternal exposures in more depth including food security indicators, alcohol use and other maternal characteristics in relation to binary measures of low birthweight and stunting among children born during the reference period. e) The final article used mobile survey data from the MomConnect database, a government database of pregnant and postnatal women. Results: a) For the scoping review, a total of 813 records were screened and 11 articles from 13 different studies met the inclusion criteria. The findings on maternal depression and maternal dietary diversity were mixed; The findings on maternal depression and children’s dietary diversity were also mixed. In the studies that examined maternal depression and dietary diversity as predictor variables for child outcomes, the findings on depression were mixed but dietary diversity was consistently associated with both cognitive and linear growth outcomes among children. b) Among children, the prevalence of stunting was 18.4% and the prevalence of wasting and overweight was 6.8% and 10.4% respectively. Children <5 and adolescents with medium dietary diversity were significantly more likely to be stunted than children with high dietary diversity. None of the indicators were associated with stunting in children aged 5-9. Among stunted children, 70.2% lived with an overweight or obese adult, the double burden of malnutrition. Among adults, increased dietary diversity increased the risk of adult overweight and obesity. c) Maternal food insecurity significantly increased the risk of depression among periconceptional and pregnant women but there was no association between maternal depression, food insecurity and mean birthweight or height-for age scores among children. d) Women who reported a child going hungry in the household in the past 12 months were significantly more likely to give birth to a low birthweight infant during the reference period. Low dietary diversity among periconceptional and pregnant women was associated with stunting among children five years later. Low birthweight significantly increased the risk of stunting among children. e) The prevalence of depression in the sample was 16% and pregnant women and new mothers who reported hunger in the household were significantly more likely to be depressed. The qualitative component of the study revealed that women’s main worries could be broadly divided into three categories; worries about hunger and food insecurity, fears that they or their children would be infected with Covid 19 and concerns about unemployment during the lockdown. Conclusion: The studies included in this PhD study demonstrate that food insecurity is an important social determinant of both physical and mental health and a potentially modifiable risk factor for low birthweight and stunting. In both studies that examined maternal depression, food insecurity significantly increased the risk of depression among periconceptional women as well as pregnant women and new mothers. In addition, food insecurity is associated with adverse child health outcomes (low birthweight, stunting and wasting). However, experiential measures of food insecurity are not associated with stunting among young children or adolescents while dietary diversity is. Dietary diversity consistently emerged as an important indicator for children’s linear growth as well as cognitive development in the scoping review. Holistic interventions that focus on the social determinants of health such as food security may improve maternal depressive symptoms among women in resource poor settings. Dietary diversity tools could be refined to also include a category for processed foods given the nutrition transition occurring in many LMICS. More longitudinal research with repeated measurements is required to elucidate the relationship between maternal depression and child health outcomes.