Use of Home-Delivered Meals to Manage Cardiometabolic Health during Pregnancy among Predominantly Black, Low-Income Women in Alabama
Camille Schneider-Worthington, Ph.D.
University of Alabama at Birmingham
Among women with pre-pregnancy overweight/obesity (OW/OB), lack of adherence to recommended dietary and gestational weight gain (GWG) guidelines may promote further deterioration in maternal cardiometabolic health, which is especially evident among Black women, lower income women, and for those who live in the Deep South.
Commonly cited barriers to healthier dietary intake among pregnant women include lack of time, access, knowledge, and skills for cooking and shopping. Thus, creative public policy initiatives are needed to improve adherence to dietary and GWG recommendations which simultaneously address the psychological (e.g., stress) and material (e.g., food insecurity, transportation) barriers and needs of pregnant women from priority populations (i.e., those deserving priority in public health and clinical efforts such as Black women, those of lower income, and those residing in the Deep South).
The provision of healthy, home-delivered meals overcomes many of these barriers that disproportionately burden low-income and minority women. In non-pregnant priority populations, meal delivery was shown to reduce stress, ameliorate food insecurity, and improve the management of OW/OB, Type 2 diabetes and cardiovascular disease. The provision of healthy, home-delivered meals for GWG management may be sustainable given the cost-savings demonstrated in other populations and the recent expansion by public and private insurers to cover home-delivered meals. However, to our knowledge, no research has examined the meal delivery model as a public health approach to manage maternal cardiometabolic health during pregnancy and address maternal-child health (MCH) disparities.
The purpose of the proposed pilot study is to test the feasibility, acceptability, and preliminary effectiveness of a meal delivery intervention targeting excessive GWG among predominantly Black and low-income pregnant women with OW/OB using a rigorous and efficient quasi-experimental design. In particular, the specific aims of this project are: 1) to assess the feasibility and acceptability of the meal delivery intervention; 2) to investigate changes in patient-reported diet quality, barriers to healthy eating, and food security; and to explore the preliminary impact of the meal delivery intervention on GWG and blood pressure relative to standard care.
This pilot project will provide essential data to inform the design of a future large-scale and fully-powered randomized controlled trial to test the clinical and cost effectiveness of the meal delivery intervention for improving MCH outcomes among priority populations. Ultimately, results could inform public policy to leverage existing programs (e.g., supplemental nutrition assistance programs) and/or modify insurance coverage to promote sustainability and the long-term possibility for meal delivery to become a covered service, thereby providing an accessible community resource and shift in health care policies with significant potential to reduce disparities in cardiometabolic disease among pregnant women and their children living in the Deep South.
