Food insecurity among pregnant women living in high-income countries: a systematic review.

BACKGROUND: Food insecurity is an increasingly important public health concern in high-income countries following the 2008 global financial crash, and recently with the COVID-19 pandemic. Food insecurity has been understood as a highly gendered issue, affecting more women than men. As women have more complex nutritional needs because of their menstrual cycle, pregnancy, and breastfeeding, the nutritional impact of food insecurity is also greater for women than for men. This systematic review aims to explore pregnant women's experiences of food insecurity in high-income countries and to understand how food insecurity affects their health, wellbeing, diet, and nutrition. METHODS: We did a systematic review following PRISMA reporting guidelines. A comprehensive search strategy was developed using search terms such as "food insecurity" and "pregnancy outcomes". We searched seven databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, and CINAHL), grey literature, reference lists, and citations, as well as contacted authors. No language restrictions were used, and only studies primarily containing data collected from Jan 1, 2008, onwards were included. Database searches were completed in April 2022; supplementary searches are ongoing. Inclusion criteria is based on PECOS. Screening, data extraction, and quality assessment were done by two authors independently. This systematic review is registered on PROSPERO, number CRD42022311669. FINDINGS: 27 studies met the inclusion criteria, with all studies published between 2015 and 2022. 24 (89%) of 27 studies were done in the USA, two (7%) in Canada, and one (4%) in the UK. Outcomes reported include dietary intake or dietary quality during pregnancy (seven [26%] of 27), gestational weight gain (seven [26%]), mental health (five [19%]), pregnancy outcomes including pregnancy complications, preterm birth, or birthweight (five [19%]), and other health outcomes or combination of nutrition, health, and wellbeing (three [11%]). Evidence synthesis is ongoing and will be complete by August, 2022. INTERPRETATION: This systematic review suggests that food insecurity experienced during pregnancy was associated with negative health and nutrition outcomes. The rigorous searches are strengths of this study. A limitation is the restricted focus on studies done from 2008 onward. More research to guide efficient interventions that address food insecurity among pregnant women is needed. FUNDING: None.

Food insecurity and the nutritional health and well-being of women and children in high-income countries: protocol for a qualitative systematic review.

INTRODUCTION: Since the global financial crises of 2008, there has been a rise in the number of people experiencing food insecurity. The COVID-19 pandemic has exacerbated this. Many more are unable to afford or access food of sufficient quality and quantity to enable good health and well-being. Particularly vulnerable are mothers with young children, pregnant women and lone parents (the majority of whom are women). This review aims to understand experiences of food insecurity and how it affects women and children's nutritional health and well-being, focusing on experiences explicitly related to nutrition. Findings will help guide health policy and practice to support food-insecure women and children from high-income countries. METHODS AND ANALYSIS: A systematic review and meta-ethnography exploring (1) food-insecure women's own accounts of their nutritional health and (2) food-insecure household's accounts of their children's nutritional health. Six major databases (MEDLINE, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), grey literature databases and relevant stakeholder websites will be searched from 1 January 2008 to 30 March 2021. Reference list and citation searches will supplement electronic database searches. Outcomes of interest are accounts of nutrition and nutritional health, including diet, food practices, infant feeding practices and physical and mental health. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines, but as this is a meta-ethnography it will adhere to eMERGe Reporting Guidance for synthesis and writing findings of the final report. Critical Appraisal Skills Programme qualitative checklist will assess the quality of studies. A meta-ethnographic analysis will be conducted for all included studies. ETHICS AND DISSEMINATION: As a qualitative systematic review, without primary data collection, ethical approval will not be required. Findings will be submitted for peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42020214159.

COVID-19 and how the wearing of face coverings can affect those with an experience of trauma.

WHAT IS KNOWN ON THE SUBJECT?: With the ongoing and possible evolving use of face coverings as a public health protection measure against the transmission of COVID-19, this is likely to be an ongoing challenge for those who find their use challenging. The wearing of face coverings following trauma is likely to be of ongoing relevance, making this an area that would benefit from further research. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The authors present their personal and professional experiences as a means of highlighting the difficulties that can be faced as a result of the use of face coverings. The window of tolerance helps to understand the difficulties that can be caused by wearing face coverings and provides a visual means of conceptualizing the cognitive, behavioural, physiological and emotional reactions that can occur as a result of their use. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper provides an awareness of the link between trauma and the wearing of face coverings, and how their use could be re-traumatizing for those accessing services. This topic is relevant across all sectors where it is only just beginning to be acknowledged that for many, particularly those with experiences of interpersonal trauma, difficulties can arise due to the use of face coverings. The sharing of grounding techniques and an introduction to the window of tolerance provides a means of collaboratively developing skills and developing a shared understanding of the difficulties associated with the use of face coverings.