Evaluation of pregnancy outcomes among food insecure women attending the Montreal Diet Dispensary program
Authors: Menard Veronique , Weiler Hope 
Published: November 2023

Introduction

Prenatal nutrition programs for women of low socio‐economic status, including the Higgins' intervention, have been successful in reducing the rate of low‐birth weight (LBW) as well as preterm births (PTB). Little is known as to the efficacy of such programs among visible minority and/or newly immigrated women of low socio‐economic status.

Objective

To determine if the Higgins' intervention was as effective at reducing pregnancy complications among women of visible minority compared to White women, as well as among immigrant women compared to those born in Canada.

Methods

The program evaluation was done using an electronic database from June 2013 to December 2015 with data on 1387 pregnancies available. Demographic information, including country of birth, time of arrival in Canada, marital status and maternal education, were self‐reported at patient's registration at 20.4 ± 7.0 weeks gestation. Pregravida weight was self‐reported, weight was then measured biweekly visit until birth. Anemia, gestational diabetes (GDM) and gestational hypertension were ascertained using copies of medical reports. Infant birth weight was collected from the vaccination booklet and Kramer's growth curve reference was used to assess size at birth. Women who were eligible to participate into the program had lower family income than the budget for basic needs determined by the Dispensary.

Results

Compared to Canadian‐born women, immigrants had similar odds of developing adverse perinatal outcomes such as preterm births (PTB), small‐for‐gestational age (SGA) and low‐birth‐weight (LBW) infants, gestational diabetes, maternal anemia and gestational hypertension. However, differences between ethnicities and immigration duration were observed. Black women were more at risk of having a PTB (adjusted odd ratio (aOR)=1.79, 95%CI: 1.01, 3.19) compared with White women, with African women mostly contributing to the increased risk (aOR= 2.67, 95%CI: 1.44, 4.90). Black women had higher anemia prevalence and gestational hypertension (aOR= 2.23, 95%CI: 1.18–4.21) than White women. Asian women had an increased risk of having a SGA infant (aOR=2.35, 95%CI:1.21, 4.56;) and GDM (aOR=1.86, 95%CI: 1.17, 2.98) compared to White women. When comparing women by region of birth, this risk was particularly higher among women from South Asia who had 2.88‐times the risk of developing GDM (2.88, 95%CI: 1.03, 8.07) compared to North Americans (Canada and USA). Anemia rates were also higher among those who immigrated to Canada more than 5 years before the assessment (5–10 y aOR= 1.99, 95%CI: 1.05, 3.78; > 10 y aOR=2.01, 95%CI:1.01, 3.99) compared to Canadian‐born.

Conclusion

The Higgins' intervention supported perinatal health in immigrants, but disparities were still present for Black and Asian women. Earlier nutritional intervention, prioritization of high risk groups of women and adaptation of the intervention would be needed to further reduce outcomes discrepancies among this vulnerable population.

Support or Funding Information

Canadian Foundation for Dietetic Research (CFDR)