STATEMENT OF BARBARA LARAIA1
Laraia stated she would discuss food insecurity during pregnancy; the outcomes from food insecurity for children, including diet, weight status, and chronic disease; and suggestions for “next steps.”
Food Insecurity During Pregnancy
Laraia reported that food insecurity during pregnancy has been associated with the low birthweight of the child (Borders et al., 2007; Hobel, 2004), which in turn is associated with insulin-resistance and glucose intolerance later in that child’s life. Thus, food insecurity during pregnancy can set the fetus up for a trajectory to be more at risk for chronic disease later in life. Using data from the National Health and Nutrition Examination Study (NHANES), 1999–2010, she and her colleagues (Laraia et al., 2013a) estimated that 10.2 percent of pregnant women were low food secure, 4.4 percent were very low food secure, and an additional 8.8 percent were marginally food secure (unpublished data).
She said that food insecurity is a chronic stressor, and the effect of stress during pregnancy was summarized in Hobel, Goldstein, and Barrett (2008). In the hypothalamus-pituitary-adrenal (HPA) axis stress feedback system of a nonpregnant woman, the hypothalamus secretes corticotrophin releasing hormone that influences the pituitary. The pituitary secretes adrenocorticotropic hormone also known as corticotropin, which acts on the adrenal glands and the kidneys. The adrenal glands, in turn, secrete cortisol and the stress response is launched. In normal conditions, cortisol can provide feedback to the hypothalamus and stop the stress response. But under chronic stress conditions, cortisol levels stay high. In pregnancy, the process is altered. Cortisol levels during pregnancy are high anyway, but under stress the cortisol can cascade and also act on the placenta. The placenta can then launch its own stress attack, releasing more corticotrophin, which can then trigger delivery or influence fetal growth. Thus, food insecurity has a real role in metabolic disturbances during pregnancy.
Laraia illustrated a conceptual framework of household food insecurity on adiposity and health (see Figure 8-1). She hypothesized strong interactions with moderators such as acculturation, genetic factors, the life course stages critical for development, stress, and dietary restraint, and the food environment. She said that for all periods where growth is occurring rapidly and fat tissue is being laid down there is a strong interaction
1Laraia and her colleagues, Cindy Leung and Amanda Murphy, prepared a commissioned paper on this topic for the workshop (Laraia et al., 2013a). Laraia acknowledged the assistance of her coauthors in developing her workshop presentation.