(PTFS06-03-25) Metabolic Health, Food Security Status, and Healthy Eating Index-2020 Scores of Pregnant U.S. Women in NHANES 2009-2023

Objectives: Maternal metabolic health during pregnancy is a critical determinant of health outcomes for mothers and children. The objective was to determine the prevalence of metabolic risk factors in pregnant U.S. women in National Health and Nutrition Examination Survey (NHANES) from 2009-2023 and examine whether differences in individual risk factors are associated with Healthy Eating Index-2020 (HEI-2020) scores and household food security (HFS) status.

Methods: Laboratory and questionnaire data were analyzed from pregnant women aged 20-44 years in NHANES 2009-2023 (n=388). Metabolic risk factors are defined as: a pre-pregnancy body mass index (BMI) of >30 kg/m^2; triglyceride of ≥150 mg/dL; high-density lipoprotein (HDL) cholesterol of < 50 mg/dL; fasting glucose of ≥100 mg/dL, blood pressure of ≥130/≥85 mmHg, and high-sensitivity C-reactive protein (hs-CRP) of >7.76 mg/dL. Associations between HEI-2020 scores and HFS status with risk factors were analyzed in multivariable logistic regression models using survey weights and adjusting for maternal age, race/ethnicity, gravidity, income-to-poverty ratio, and education.

Results: Among pregnant women, 58.8% (95% CI: 52.2%, 65.4%) had at least one metabolic risk factor. Prevalence of pre-pregnancy obesity was 23.8% (95% CI: 17.9%, 29.6%), hypertriglyceridemia was 41.4% (95% CI: 29.8%, 53.0%), low HDL was 18.8% (95% CI: 13.0%, 24.5%), hyperglycemia was 14.6% (95% CI: 7.6%, 21.6%), hypertension was 5.9% (95% CI: 2.3%, 9.5%), and high hs-CRP was 23.1% (95% CI: 13.4%, 32.8%). Very low HFS status was associated with higher odds of low HDL (OR: 2.28, 95% CI 2.23, 2.32) and hypertension (OR: 5.02, 95% CI: 4.87, 5.17). A 1-point increase in HEI-2020 scores was associated with lower odds of hypertension (OR: 0.954, 95% CI: 0.953, 0.954), high hs-CRP (OR: 0.939, 95% CI: 0.938, 0.940), and hypertriglyceridemia (OR: 0.991, 95% CI: 0.990, 0.991).

Conclusions: Household food security status and diet quality scores were associated with prevalence of metabolic risk factors in U.S. pregnant women. Improving household food security and diet quality scores may be effective in improving metabolic health in pregnant U.S. women.

Funding Sources: Floyd and Mary Schwall Fellowship, Lurie Graduate Student Award, Big Bang Theory Fellowship (Chuck Lorre Family Foundation)