Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females.

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities. American Indian and Alaska Native (AI/AN) women are disproportionately impacted by gestational diabetes mellitus (GDM). GDM can cause severe perinatal complications for both mother and baby. Weight management through healthy diet and physical activity are key factors in decreasing risk for GDM. However, there are barriers to healthful eating in many AI/AN communities. Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is a risk factor for unwanted weight gain. Living in a food insecure household during preconception and pregnancy may increase risk of greater weight gain. In this paper, we examined the relationship between food insecurity with healthy eating self-efficacy and behaviors among AI/AN adolescents and young adults (AYAs) (n = 149) through secondary analysis of an existing randomized controlled trial dataset. This study offers unique insight regarding “upstream causes” of GDM health disparities among AI/AN communities. Food security had some moderating effects on individual eating behaviors. Additionally, both healthy eating behavior and self-efficacy for healthy eating improved more among the AYA who experienced food insecurity at baseline. Given the intergenerational implications of GDM, it is prudent that the healthcare sector works with AI/AN communities to support healthful eating behaviors and environments to decrease GDM disparities.

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© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.