Journal of Preventive Medicine

Introduction
Limited access to adequate and safe foods is defined as food insecurity. During pregnancy, food insecurity can have negative effects on the mother and fetus. Adequate nutrition during this critical period of life is needed to prevent nutrient deficiencies in both mother and child, and can potentially affect both short- and long-term health of mother and child. Therefore, in addition to promoting childbearing, appropriate policies for healthy fertility should also be provided. Considering the lack of related studies in Iran, the present study aims to investigate food security in pregnant women in Yazd, Iran, and assess its relationship with sociodemographic factors.

Methods
This is a descriptive cross-sectional study that was conducted in 2020 on 240 pregnant women aged 18-40 years with a gestational age of 28-36 weeks (7-9 months of pregnancy) who visited health centers in Yazd city to receive prenatal care. Suffering from chronic and inflammatory diseases before pregnancy such as diabetes, high blood pressure, cardiovascular diseases, liver and kidney diseases, unwillingness to continue participation in the study, and return of incomplete questionnaires were the exclusion criteria. The sampling was done using stratified two-stage cluster sampling method. Two health centers were randomly selected from each of the four regions of Yazd city (based on the classification of Yazd Municipality) and then 30 eligible pregnant women were selected from each center.
The data was collected using a four-part questionnaire. The first part surveys personal information (age, occupation, last educational degree, number of children). The second part was related to pregnancy-related information (anthropometric indicators, pregnancy complications including gestational diabetes, high blood pressure, anemia, and urinary proteinuria; history of abortion, history of premature birth, history of stillbirth, and unwanted pregnancy). The third part was related to the infant-related information (head circumference, weight, height, and sex). The fourth part was the household food insecurity access scale (HFIAS) with 9 items rated on a 4-point Likert scale (often, sometimes, rarely, and no). The questionnaires were completed by face-to-face interviews. The data were analyzed in SPSS software, version 20 using chi-square test, independent t-test, ANOVA, and univariate and multivariate logistic regression analyses.

Results
The results showed that 167 women (69.6%) were food secure, 59(24.6%) were mildly food insecure, 13(5.4%) were moderately food insecure, and one (0.4%) was severely food insecure. The results of univariate logistic regression analysis showed that the odds of food insecurity in housewives was 3.93 times more than in employed women (OR=3.93, P=0.013). Also, pregnant women with more than 2 children were 4.05 times less likely to have food insecurity than women with fewer children (OR=4.05, P<0.001). Moreover, the odds of food insecurity in pregnant women with lower than high school education was 2.36 times more than in pregnant women with university education (OR=2.36, P=0.013). The odds of food insecurity in pregnant women under 20 years old was 1.69 times more than in women over 20 years old (OR=1.69, P=0.18). Women with unplanned pregnancies were 2.54 times more likely to have food insecurity (2.54, OR=P=0.03). Based on the final logistic regression model and after controlling the confounding factors, it was determined that only the number of children could predict the risk of food insecurity (P<0.001, OR=4.05).

Conclusion
The prevalence of food insecurity in the studied pregnant women was 30.4%. The prevalence of food insecurity are different in different cities and populations. Such differences may be due to factors such as community policies, socioeconomic status, household size, etc. Also, the scales used for measuring food insecurity are different. Food security in pregnant women was influenced by variables such as occupation, educational level, number of children, and pregnancy planning. Pregnant mothers with food insecurity were less educated and housewives with more children and younger age. Maintaining or improving the food safety of pregnant women in Yazd requires proper educational nutrition programs and the development of food standards based on socioeconomic and cultural status. Also, continuous assessment of food security during prenatal care and the development of policies for granting food packages to pregnant mothers should be on the agenda.

Ethical Considerations
Compliance with ethical guidelines
Before conducting the interview, the purpose of the study was clearly explained to the pregnant women and they were assured that their information will be confidential and will not be used for anything other than the present study. Written informed consent was also obtained from pregnant women. The present study was approved by the Ethics Committee of the Faculty of Health, Shahid Sadoughi University of Medicine (Code: IR.SSU.SPH.REC.1398.119).

Funding
This study was financially supported by the Shahid Sadoughi University of Medical Sciences.

Authors' contributions
Study design, data collection and writing article: Mahdieh Momayyezi; Statistical analysis and revision: Hossein Falahzadeh.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the pregnant women who participated in this study.



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