Project Summary/Abstract Food insecurity has been linked to adverse health outcomes in children and adults, including obesity and cardiovascular disease (CVD). Much less is known about health effects of food insecurity around pregnancy, but there is substantial reason for concern, especially given that more than 1 in 10 pregnancies are affected. Food insecurity often results in higher intake of fast and highly processed foods, leading to an unhealthful, pro- inflammatory dietary pattern. Intake of highly processed foods also may lead to greater exposure to synthetic endocrine disrupting chemicals (EDCs) contaminating these foods or their packaging. Pro-inflammatory diets and EDC exposures each predict pregnancy complications, including excessive gestational weight gain (GWG), gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), depressive symptoms, and small or large for gestational age birth (SGA and LGA). These prenatal complications presage excess long-term CVD risk for mother and child alike. People of color, especially non-Hispanic Black and Hispanic women and their children, are at highest risk for food insecurity as well as pregnancy complications. Racial and ethnic inequities in these risks, and in CVD itself, are widening with time. Neighborhoods have emerged as highly relevant contexts because they possess both physical (e.g., access to healthy food choices) and social (e.g., availability of social services) attributes that can drive and interact with individual-level food insecurity, which translates into poorer health that contributes to health inequities. Understanding these relationships will help inform policies that aim to reduce excess CVD risk in both mothers and children. Leveraging our team’s expertise in nutritional, social, and environmental epidemiologic research in the peripartum period and early childhood, we propose to initiate a new cohort that will participate in the nationwide Environmental influences on Child Health Outcomes (ECHO) program. We will recruit 800 pregnant people and their offspring from racially, ethnically, and socioeconomically diverse neighborhoods in the Boston, MA area and collect data from early pregnancy onwards, including enrolling repeat pregnancies with preconception measures. We will conduct solution-oriented science within the unparalleled ECHO data platform, with the overall goal of better understanding how food insecurity and related neighborhood and individual characteristics contribute to pregnancy conditions that lead to later obesity and CVD risk.

Project Narrative Understanding the structural factors that contribute to food insecurity and its downstream impact on social, racial, and ethnic inequities in diet quality, environmental chemical exposures, and pregnancy complications is imperative for identifying early-life and modifiable risk factors to improve women’s and children’s cardiometabolic health.