Food Choice and Dietary Perspectives of Young, Urban, Black Pregnant Women: A Focus Group Study.

Black pregnant women in Chicago are disproportionately affected by maternal morbidity and mortality and are more likely to reside in neighborhoods that experience greater economic hardships and food apartheid than any other race/ethnicity. Addressing social determinants of health such as structural inequities, economic environment, and food apartheid issues may provide insights into eliminating Black maternal morbidity and mortality disparities. This study explores food choice determinants and dietary perspectives of young, urban, Black pregnant women. Two audio-recorded focus groups were conducted in Chicago, IL between March 2019 and June 2019 to discuss pregnancy experiences and factors affecting maternal nutrition. Thematic analysis was used to identify the codes, themes, and subthemes of the data. Data analysis was guided by the Social Ecological Model (SEM) as a theoretical framework. Eleven, young, Black women were recruited. Three major themes were discussed across the SEM levels that influenced food choice including food access, stress and family influences on eating, and the need for nutritional education during pregnancy. These choices were primarily rooted in the detrimental effects of food apartheid experienced within the participants' neighborhoods. Therefore, acknowledging, understanding, and addressing food apartheid and its impact on Black maternal health disparities is needed in clinical practice, research, and policy change.

Correction: OjiNjideka Hemphill et al. Feasibility Study of Lactobacillus Plantarum 299v Probiotic Supplementation in an Urban Academic Facility among Diverse Pregnant Individuals. Nutrients 2023, 15, 875.

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Structural Violence and Stress Experiences of Young Pregnant Black People.

INTRODUCTION: Approximately 10-20% of individuals suffer from mental health concerns during the prenatal period due to their vulnerability and emotional responses to stressful events. Mental health disorders are more likely to be disabling and persistent for people of color, and they are less likely to seek treatment due to stigma. Young pregnant Black people report experiencing stress due to isolation, feelings of conflict, lack of material and emotional resources, and support from significant others. Although many studies have reported the types of stressors experienced, personal resources, emotional stress responses on pregnancy, and mental health outcomes, there is limited data on young Black women's perceptions of these factors. METHODS: This study utilizes the Health Disparities Research Framework to conceptualize drivers of stress related to maternal health outcomes for young Black women. We conducted a thematic analysis to identify stressors for young Black women. RESULTS: Findings revealed the following overarching themes: Societal stress of being young, Black, and pregnant; Community level systems that perpetuate stress and structural violence; Interpersonal level stressors; Individual level effects of stress on mom and baby; and Coping with stress. DISCUSSION: Acknowledging and naming structural violence and addressing structures that create and fuel stress for young pregnant Black people are important first steps to interrogating systems that allow for nuanced power dynamics and for recognizing the full humanity of young pregnant Black people.

Feasibility Study of Lactobacillus Plantarum 299v Probiotic Supplementation in an Urban Academic Facility among Diverse Pregnant Individuals.

(1) Background: Despite iron intake recommendations, over a quarter of pregnant individuals have iron deficiency. Lactobacillus plantarum 299v (Lp299v®) enhances iron absorption in non-pregnant populations and may have positive effects in pregnancy among those with sufficient iron stores; however, no studies have evaluated the effect of Lp299v® on maternal and neonatal iron status among individuals at risk for iron deficiency anemia in pregnancy. Thus, this study aims to assess the feasibility and preliminary efficacy of daily oral Lp299v® maternal supplementation among diverse pregnant individuals. (2) Methods: In this double-blind placebo-controlled randomized supplementation feasibility study, participants were randomized to probiotic Lp299v® + prenatal vitamin with iron or placebo + prenatal vitamin with iron from 15-20 weeks of gestation through delivery. (3) Results: Of the 20 enrolled and randomized participants, 58% (7/12) from the Lp299v® group and 75% (6/8) from the placebo group were retained. Adherence to supplementation was 72% for Lp299v®/placebo and 73% for the prenatal vitamin. A slower decline in maternal hematological and iron parameters across pregnancy was observed in the Lp299v® group compared to placebo. (4) Conclusions: Lp299v® may be a tolerable therapy during pregnancy and has the potential to affect maternal and neonatal hematological and iron status.

Obstetric experiences of young black mothers: An intersectional perspective.

BACKGROUND: In Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities - including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. METHODS: In this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. RESULTS: We developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants' healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. CONCLUSIONS: The current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.

Recruitment and Retention of Urban Pregnant Women to a Clinical Study Administering an Oral Isotope Dietary Tracer.

Introduction: Pregnant women are a vulnerable population that are difficult to engage in clinical research. We report successful recruitment and retention strategies used in a longitudinal pilot study of urban racially/ethnically diverse pregnant women that involved administration of an orally ingested isotope tracer, multiple venipunctures, biopsy of placenta after delivery, and cord or placental blood collection. Materials and Methods: We used direct strategies to recruit English-speaking obese and nonobese pregnant women aged 17-45 years, who were in the third trimester of pregnancy. The study required data collection at 32-34 and 34-36 gestational weeks and delivery. Strategies included frequent personal engagement with participants and staff to build relationships and trust, tangible appreciation, and the study team being present at delivery. In addition, leveraging hospital information technology (IT) services was critical to ensure retention through labor and delivery (LD). Results: A racially (52% Black, 23% White, and 10% other) and ethnically (15% Hispanic or Latinx) diverse sample of pregnant women was enrolled. Of the 52 women enrolled, 85% of women completed all procedures. Conclusions: This is the first report of successful strategies for recruitment and retention of racially/ethnically diverse pregnant women in a longitudinal study requiring oral administration of an isotope tracer. Personal engagement with multiple touch points, starting with recruitment and continuing regularly throughout the third trimester, was the most successful strategy. Creating and maintaining relationships with the LD providers and staff and utilizing hospital IT, including targeted electronic medical record alerts, ensured successful retention for the duration of the study. Trial Registration: Not applicable.

Validation of a self-report home food availability checklist against in-home food inventories conducted in low-income Black/African American and Hispanic/Latinx households with preschool-age children.

Home food availability (HFA) checklists can be completed by self-report to assess the home food environment. Checklists developed for Black/African American (B/AA) and Hispanic/Latinx (H/L) households are seldom validated against objective approaches such as exhaustive in-home food inventories. This study validated a self-report HFA checklist developed for B/AA and H/L households (n = 97) against researcher-completed HFA checklists verified by exhaustive in-home food inventories. Mean estimates of sensitivity, specificity, and area of the receiver operating curve (ROC), and interrater agreement (Gwet AC1) were calculated to examine the accuracy and agreement of self-reported checklists against direct observation of individual food items. Mean differences in HFA food group scores were compared (self-report vs observed) to examine group-level relative validity. The predictive validity of this self-reported measure on observed scores and dietary intake were also examined with linear regression. The average values for ROC area (average of sensitivity and specificity) ranged from acceptable (0.76 for sweets) to excellent (0.81 for vegetables, fruits). Average interrater agreement values ranged from moderate (0.41-0.60: sweets) to substantial (0.61-0.79: vegetables, fruit, SSBs, savory foods). Self-reported mean scores, compared to observed scores, were higher for vegetables (mean diff: 1.04) and lower for sweets (mean diff: 0.38, p = 0.01), but regression analyses demonstrated that self-reported scores were good predictors of observed scores with absolute error (based on standard deviation of residuals) ranging from ±1.27 to 1.69 points. Self-reported scores also predicted multiple aspects of dietary intake but more so among H/L households. In conclusion, the HFA checklist obtained via self-report performed well based on multiple indicators of validity suggesting that this self-reported measure can be used to assess home food environments among of B/AA and H/L households.

Examining disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis.

Recent studies have reported that SNAP participants have poorer diet quality than non-participants. This study aimed to examine how differences in socio-demographic, household, and health-related measures explain disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. We analyzed cross-sectional data on 14,331 adult respondents of the National Health and Nutrition Examination Survey (NHANES) 2009 - 2014. To measure diet quality, we applied the Healthy Eating Index (HEI)-2015 to respondents' 24-hour dietary recall data (scale: 0-100 points). We used Oaxaca-Blinder decomposition analysis to determine how much of the disparity in HEI-2015 total score between SNAP participants and non-participants was explained by socio-demographic (e.g., age, race/ethnicity, educational), household (e.g., household size, food security status), and health-related measures (e.g., BMI, smoking status). Analyses performed revealed significant differences in HEI-2015 total score by SNAP participation status (p < 0.001). We found that the total gap in HEI-2015 total score between SNAP participants and income-ineligible non-participants was 6.30 points. Socio-demographic measures alone explained 72.40% of the disparity. All measures together explained 86.31% of the disparity. The total gap between SNAP participants and income-eligible non-participants was 3.24 points. Socio-demographic measures alone explained 35.51% of this disparity while all measures together explained 56.86%. We observed disparities in diet quality between SNAP participants and non-participants. Socio-demographic, household, and health-related measures explained a significant amount of the disparity that existed between SNAP participants and income-ineligible non-participants; they explained less of the disparity between SNAP participants and income-eligible non-participants.

Racial/Ethnic Differences in the Shopping Behaviors and Fruit and Vegetable Consumption of Farmers' Market Incentive Program Users in Illinois.

Introduction: Farmers' market incentive programs, such as Link Match, provide monetary incentives to Supplemental Nutrition Assistance Program (SNAP) participants to promote their use of local farmers' markets. Information on racial/ethnic differences in the shopping behaviors and fruit and vegetable (FV) consumption of farmers' market incentive program users is scarce. This research aimed to address this need by examining users of the Link Match incentive program in Illinois. Methods: A cross-sectional survey of 328 Link Match users (39.6% non-Hispanic White; 45.4% non-Hispanic Black; and 15.0% other) was conducted in 2016 and 2017. Information on each participant's demographics, farmers' market shopping behaviors, and monthly frequency of FV consumption was collected from Link Match users. Chi-square and ANOVA tests were used to assess differences in farmers' market shopping measures by race/ethnicity. Logistic regression models were used to examine the association between race/ethnicity and frequency of FV consumption. Results: A significantly higher percentage of non-Hispanic Black participants reported being an infrequent farmers' market user (ie, shopping ≤ once a month) compared with non-Hispanic White and other participants (P=.01). After adjusting for covariates, non-Hispanic Black participants had lower odds of consuming fruit daily (OR: .44; 95% CI:.22-.86) compared with non-Hispanic White participants. Other participants had lower odds of consuming both fruit and vegetables compared with non-Hispanic White participants (OR: .30; 95% CI:.12-.71). Conclusions: Differences in shopping behaviors and FV consumption were observed by race/ethnicity among Link Match users. Future research should examine the nutritional implications of these differences.