Food and Nutrition Insecurity During Pregnancy in French Guiana

Study Overview
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Brief Summary
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This is a cross-sectional study of a representative sample of women who gave birth in the 3 maternity hospitals of French Guiana. The main objective is to estimate the prevalence of food insecurity among pregnant women admitted for delivery in one of the maternity hospitals of French Guiana. A biological assay of deficiencies and toxic metals as well as the completion of a questionnaire will answer the research question

Detailed Description
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According to the FAO, the gender gap in the prevalence of moderate and severe food insecurity widened in the year of the pandemic, with the prevalence of food insecurity among women 10% higher than among men. Scientific projections have estimated that the increased prevalence of wasting with the pandemic in low- and middle-income countries would result in 18-23% more deaths among children. Worst-case scenarios predict an increase of 8.3 to 38.6% in maternal deaths per month in low- and middle-income countries. The systemic nature of food insecurity among pregnant women underlines the need to address it in a comprehensive and cross-cutting manner. It seems relevant to consider it as a major determinant of the health of populations that closely follows and feeds other health determinants (precariousness, low standard of living, housing conditions, etc.) or other health consequences (pregnancy monitoring, quality of life, deficiencies, body weight, etc.). The quality of life would be affected with an increase in stress, anxiety and depression. The link between malnutrition and household food insecurity has already been suggested. Iron deficiency anaemia was significantly associated with food insecurity in the pregnant woman's household; it also predisposes to the risk of anaemia in children under 5. According to the WHO, anaemia is a major public health problem worldwide. It affects 40% of pregnant women, with a risk of irreversible effects on the child's brain development. According to longitudinal studies, the risk of premature delivery seemed to be more frequent when the pregnant woman was in a situation of food insecurity. A diet deficient in essential micronutrients is also thought to increase the risk of low birth weight, according to studies conducted on the African continent. In Guiana between 2019 and 2020, the CARMA study measured micronutrient deficiencies (Iodine, Iron, Zinc, Vitamin A, folic acid, Vitamin 12) in women at the time of their delivery in Cayenne. This study revealed a high prevalence of micronutrient deficiencies with 81% of parturients having at least 1 deficiency and 46% having at least 2 deficiencies. The authors suggest that the negative impact of heavy metal impregnation is a factor that aggravates deficiencies. This research takes a global approach to the problem of food security and does not focus on one type of nutritional deficiency or on a pregnancy-related pathology. The idea is to study the links, aggravating effects and interactions between access to food, situations of precariousness, deficiencies, lead or mercury intoxication and the impact with pathologies. This strategy is based on the hypothesis that there are permanent interactions between minerals, vitamins and heavy metals and that their impact on the health of the pregnant woman and the newborn is conditioned by these interactions and by the maternal and family background.

Official Title
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Food and Nutrition Insecurity During Pregnancy in French Guiana

Conditions
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Food Insecurity, Pregnancy Related

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women admitted for delivery in one of the maternity hospitals in French Guiana Exclusion Criteria: refusal to participate or lack of collected non-opposition lack of parental consent for women under 18 years of age.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Household food insecurity | The primary measure of household food security was conducted using the Household Food Security Scale (HFSSM) validated by the United States Department of Agriculture (USDA) at inclusion | At inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of coping strategies | Description of the coping strategies using the Coping Strategies Index (CSI) in the past 3 months The Coping Strategy Index (CSI) is an indicator of a household's food security assessing the extent to which households use harmful coping strategies when they do not have enough food or enough money to buy food. The result is reported by a numeric score | At inclusion | 
| Evaluation of the Food Insecurity Experience | Description of the food insecurity experience using the Food Insecurity Experience Scale (FIES) in the past 3 months The FIES-SM questions refer to the experiences of the individual respondent or of the respondent's household as a whole. The questions focus on self-reported food-related behaviors and experiences associated with increasing difficulties in accessing food due to resource constraints | At inclusion | 
| Evaluation of the food consumption frequencies in the past 3 months | Description of the food consumption frequencies in the past 3 months using a face-to-face questionnaire | At inclusion | 
| Evaluation of the socio-demographic profile of the household | Description of the socio-demographic profile of the household at inclusion according to food insecurity level, by face-to-face questionnaire | At inclusion | 
| Evaluation of the economic profile of the household | Description of the economic profile of the household at inclusion according to food insecurity level, by face-to-face questionnaire | At inclusion | 
| Evaluation of the micronutrient deficiencies | Evaluation of the micronutrient deficiencies by measuring biomarkers of nutritional status : vitamins and mineral levels, toxic metals in blood and urine | At inclusion | 
| Evaluation of the self esteem | Description of the self esteem using the Rosenberg Self-Esteem scale by a face-to-face questionnaire The scale ranges from 0-30, with 30 indicating the highest score possible Scores between 15 and 25 are within normal range; scores below 15 suggest low self-esteem | At inclusion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nutrition, French Guiana, Pregnancy, Food security, Cross-section study, Social inequality in health