Peer-reviewed article

Cardiometabolic Risk in United States Pregnant Women and Associations with Food Insecurity, Diet Quality, and Special Supplemental Nutrition Program for Women, Infants, and Children Participation.

Chharawalla HM, Nommsen-Rivers LA, Arnold CD, Leung CW, Au LE · 27 Jun 2026

Abstract

Background Suboptimal cardiometabolic health in pregnancy increases risk of perinatal complications and long-term negative health outcomes. Objectives This study aimed to provide updated prevalence estimates of cardiometabolic risk factors among United States pregnant women, and examine associations with food insecurity, diet quality, and United States Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Methods This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2023. This analysis included pregnant women aged 20-44 y. From 1999 to 2023, 1538 women had available cardiometabolic data to estimate prevalence, which were examined using survey-weighted descriptive statistics. Associations of cardiometabolic outcomes with food insecurity, diet quality, and WIC participation were examined using survey-weighted multivariable linear regression models. Food insecurity was assessed using the United States Food Security Survey. Diet quality was assessed with Healthy Eating Index-2020 (HEI-2020) scores using the simple ratio method. WIC participation was ascertained from the Food Security Questionnaire. Models were adjusted for age, race/ethnicity, gravidity, income, education, and marital status. Outcomes included prepregnancy body mass index (BMI), fasting plasma glucose, blood pressure, high-density lipoprotein cholesterol (HDL-cholesterol), and C-reactive protein (CRP). Results Prepregnancy overweight/obesity was found in 51.9% of women, elevated fasting glucose in 29.3%, and elevated blood pressure or hypertension in 10.7%. The median HDL-cholesterol in the highest quartile was 84 mg/dL [interquartile range (IQR): 78-93], and for CRP was 14.6 mg/L [IQR: 12.4-16.8]. Food insecurity was associated with lower HDL-cholesterol [β = -4.02, standard error (SE) = 2.03; P = 0.05], but not with CRP, fasting glucose, or blood pressure. Higher HEI-2020 scores were associated with higher HDL-cholesterol levels (β = 1.45; SE = 0.71; P = 0.04), but not with CRP, blood pressure, or fasting glucose. Participation in WIC strengthened the positive association between HEI-2020 scores and systolic blood pressure. Conclusions Prevalence of cardiometabolic risk factors was high among United States pregnant women, with food insecurity and suboptimal diet quality associated with some risk factors.