Food is medicine for pregnant women: A missed opportunity in maternal and child health

1. NUTRITION IN PREGNANCY

To maintain a healthy pregnancy, a balanced and nourishing dietary pattern is essential for expectant mothers. This practice supports the mother's health and the baby's development, ensuring optimal fetal growth and preparing the mother for the demands of childbirth and postpartum recovery [1]. Proper nutrition optimizes pregnancy outcomes and reduces adverse outcomes such as gestational diabetes and low birth weight while promoting overall health for the mother and baby [2]. By prioritizing nutrition, women can significantly improve health outcomes for themselves and their children [3].

Adequate intake of essential nutrients supports development of fetal organ systems and can help prevent birth defects, developmental delays, and chronic health conditions. Furthermore, the intrauterine environment plays a crucial role in shaping the metabolic health of the fetus, affecting the risk of obesity and cardiovascular diseases in adulthood [4]. Perturbations in the intrauterine environment from maternal disease, malnutrition, or overnutrition can alter the structure and function of fetal organs, potentially increasing the risk of health complications [5].

Food is medicine (FIM) encompasses a range of strategies that addresses the nutrition needs of a variety of patient populations ranging from disease‐specific treatment to population level programs addressing food access and food insecurity [6]. FIM creates synergy with other therapies and goes beyond simply providing food, ideally having an educational component and providing access to medically tailored food and nutrition services based on specific diet‐sensitive conditions. This concept has grown in the nonpregnant literature and demonstrated significant improvements in health alongside cost reduction [6, 7, 8, 9]. Pregnancy is an ideal stage for implementing FIM interventions, as women are often motivated to optimize the health of their baby. FIM programs may include opportunities for education with dietitian nutritionists that build not only a nutritional foundation but also a culinary literacy for practical food preparation [10].

Considerable disparities in maternal health and nutrition exist, particularly among racial and ethnic minority groups who often have limited access to nutritious foods [11]. In response to the growing malnutrition rates in low‐income families, the US Department of Agriculture created the Special Supplemental Food Program for Women, Infants, and Children (WIC) in 1974. The goal of WIC is to provide food assistance to pregnant and breastfeeding women, as well as their children up to age 5 [12]. The WIC program is a national nutrition support program that addresses food insecurity by improving access and stability, and many have studied the health impacts for women and children. Despite being one of the earliest concepts demonstrating the potential for FIM, WIC has not always prioritized nutritionally appropriate food, does not tailor the food to medical needs, and does not typically provide meal preparation education.

The concept of FIM focuses on the link between access to nutritious food and good health [13]. Recently, public health initiatives have explored food assistance modalities to enhance patient access to quality nutrition [14]. These modalities include fruit and vegetable voucher programs, cash‐based food assistance programs, medically tailored meals and groceries, produce prescriptions, culinary medicine educational programs, and personal nutritional counseling services [15, 16]. While there is extensive evidence supporting the importance of maternal nutrition for pregnancy outcomes, research on FIM interventions during pregnancy remains very limited.

2. EXAMINING THE LIMITED LITERATURE

A literature review focused on US studies of food‐based nutrition interventions for pregnant women reveals limited publications examining maternal or neonatal health outcomes (PubMed, MEDLINE, MEDLINE InProcess & EPub, and CINAHL, English language, 2000–2024, Supporting Information). Relevant nutrition interventions included WIC participation, food and vegetable vouchers, culinary classes, or meal kit deliveries through varied design strategies including randomized control trials, prospective, and retrospective studies (Table 1). Of the 19 identified studies, 14 focused on WIC enrollment as the primary intervention [17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30]. Two added fruit and vegetable vouchers to WIC participants [31, 32]. The three studies unrelated to WIC utilized food provision strategies with or without an educational component: weekly meal‐kit deliveries, nutritional counseling with fresh meals at each meeting, and counseling with fruit and vegetable vouchers and cooking classes [3]. Most (68%) utilized a retrospective design.

TABLE 1.

The location, study design, intervention, sample size, and the outcomes of the included studies.

Authors	Study location	Study design	Intervention	Sample size	Outcome
Bitler and Curie [17]	United States	Retrospective	WIC enrollment	60,731	WIC enrollment affords women the opportunity to have healthier infants.
Blakeney et al. [18]	Washington State and Florida	Retrospective	WIC enrollment	226,835	Enrollment in WIC is associated with an increase in infant birth weight.
Clark et al. [19]	United States	Retrospective	WIC enrollment	460,377	Women with gestational diabetes mellitus enrolled in WIC were significantly less likely to have a preterm delivery, and their infants were significantly less likely to need a ventilator within six hours of life.
El‐Bastawissi et al. [20]	Washington State	Retrospective	WIC enrollment	42,495	WIC enrollment protected against preterm birth, low birth weight, and fetal death when controlled for abortion history, access to prenatal care, cervical health, and education.
Ferris et al. [33]	Missouri	Interventional	Weekly deliveries of meal kits, nutrition education, care coordination, and supportive services	125	Mothers enrolled in the program had decreased rates of depression and had fewer preterm and low birth weight births.
Fingar et al. [21]	California	Retrospective	WIC enrollment	236,564	WIC enrollment and the number of food packages redeemed are associated with decreased preterm births.
Gueorguieva et al. [22]	Florida	Retrospective	WIC enrollment	369,535	Longer enrollment in WIC is associated with a decreased risk of delivering a small‐for‐gestational age infant.
Hamad et al. [23]	California	Retrospective	WIC enrollment	2,897,537	Enrollment in WIC and utilization of the food package were associated with decreased rates of preeclampsia and gestational diabetes and increased gestational weight gain within normal limits. Infants were more likely to be appropriate for gestational age, have a lower birth weight, and they were less likely to be readmitted within the first year.
Joyce et al. [24]	New York	Retrospective	WIC enrollment	48,598	Enrollment in WIC has minimal impact on birth outcomes for enrolled women living in New York.
Joyce et al. [25]	United States	Retrospective	WIC enrollment	2,781,699	Enrollment in WIC has a modest beneficial effect on fetal growth.
Khanani et al. [26]	Ohio	Retrospective	WIC enrollment	24,008	African American infant mortality rate is lower in WIC participants compared to non‐WIC participants
Morales et al. [27]	Massachusetts	Retrospective	Participation in Food for Families Program: a program that connects food‐insecure patients with SNAP, WIC, and food pantries	1295	Women enrolled in Food for Families had significantly lower systolic and diastolic blood pressure trends. There was no statistically significant difference in blood glucose trends.
Ridberg et al. [31]	California	Prospective	WIC participants receive an additional $40/month fruit and vegetable voucher	700	An increase in food security decreases preterm birth in mothers on a WIC based fruit and vegetable voucher program.
Sonchak [28]	South Carolina	Retrospective	WIC enrollment	102,079	WIC Participation increases birth weight and length of gestation and decreases NICU admission.
Testa and Jackson [29]	United States	Retrospective	WIC enrollment	210,271	Enrollment in WIC reduces adverse infant health outcomes in African American and Hispanic populations.
Venkatesh et al. [30]	United States	Cross‐sectional ecological study	WIC enrollment	1,945,914	Enrollment in WIC decreases the likelihood of maternal gestational diabetes mellitus, ICU admission and transfusion, and neonatal ICU admission and preterm birth.
Wang et al. [32]	California	Retrospective	WIC participants receive additional $40 fruit and vegetable voucher	1,831,649	There are no significant differences in maternal or neonatal outcomes in mothers who received additional vouchers for food and vegetables.
Watt et al. [3]	Texas	Prospective	Fruit and Vegetable vouchers, nutrition and cooking classes, and lactation counseling	43	Women in the intervention groups reported lower rates of depression and had improvements in diet and exercise measures.

Abbreviations: ICU, intensive care unit; NICU, neonatal intensive care unit; SNAP, Supplemental Nutrition Assistance Program; WIC, Special Supplemental Food Program for Women, Infants, and Children.

The WIC program studies mainly found significant improvements in maternal and neonatal health. Despite inconsistent uptake of the fruit and vegetable vouchers in the intervention group, they found significant improvements in diet, exercise, and depression scales compared to the control group. This study also tracked dietary patterns over time, comparing the maternal diet from the first trimester to the third trimester. Women in the intervention group significantly increased fruit, vegetable, and protein consumption while significantly reducing fast food and chips [3]. Another utilized a FreshRx program that provided fresh food, pantry staples, cooking and nutrition education, mental health support, and resources to help participants overcome cooking barriers. There was a significant decrease in maternal depression, preterm birth, and low birth weight infants in the intervention group [33]. Of the two WIC‐focused studies without significant impact, one study employed fruit and vegetable vouchers for WIC participants but did not find improved maternal and neonatal outcomes compared to WIC alone [24, 32]. The second in New York State found WIC enrollment to have minimal measurable impact on birth outcomes [24, 32].

3. THE OPPORTUNITY FOR FIM IN PREGNANCY

Providing fresh produce, meal kits, culinary education, or tailored counseling alongside prenatal care may amplify the benefits of traditional medical interventions. As pregnant women engage with prenatal care at regular intervals, the integration of FIM tailored to both educational and logistical needs may allow for intensive support and opportunities to measure engagement, particularly with populations facing gestational diabetes, pregnancy induced hypertension, or other risks for complications to mother or fetus. Pregnancy itself also enhances motivation for behavior change, offering an opportunity for longer term nutrition planning and skills building, both key tenants of food as medicine programs that utilize teaching kitchens and other educational strategies.

While most FIM efforts currently focus on urgent, expensive health crises, the ultimate goal is to shift from treatment to prevention. As such, building habits that support improved nutrition in pregnancy set the stage for impactful habit changes for both mothers and their children. For example, strategies that support access to nourishing food paired with relevant nutrition education could introduce sources of iron, calcium, and vitamin D and support both maternal recovery from pregnancy and the nutrition of breastfed infants. For example, a study focused on hands‐on, kitchen‐based nutrition education for families improved dietary quality and led to cost savings on food expenses, investing in the health promotion and prevention for the entire family through skills‐building [34].

4. A CALL FOR FIM RESEARCH IN PREGNANCY

Future research must go beyond retrospective and observational studies to evaluate the impact of FIM interventions on maternal and neonatal health. Prospective trials should integrate food provision, education and skills building, and medical care to build a robust evidence base. To reduce disparities in maternal health outcomes, these studies should emphasize the inclusion of representative populations and co‐design strategies to develop sustainable, scalable approaches.

In addition to the need for core development and evaluation of FIM studies in the obstetric population, core metrics should include sustained dietary changes, cost‐effectiveness, self‐efficacy, and long‐term maternal‐child health outcomes. Addressing these gaps will allow the development of evidence‐based practices that support women's ongoing health and dietary needs through and after their obstetric journey.

5. CONCLUSION

Integrating FIM interventions into prenatal care is not just an opportunity to improve pregnancy outcomes, but a transformative approach that goes beyond traditional programs like WIC. By bridging the gap between nutrition and medicine, FIM serves as a critical tool to improve health outcomes for mothers and children.

AUTHOR CONTRIBUTIONS

Jaclyn Albin, Nicole A. Beckley, and Catherine Spong designed research approach, conducted research, and analyzed data. Nicole A. Beckley wrote the first draft of the paper. Anne Ambía, Catherine Spong, Jaclyn Albin, Rachel Clark, and Robert Martin edited the paper. Jaclyn Albin had primary responsibility for final content. All authors read and approved the final manuscript.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Supporting File: pmf270042‐sup‐0001‐SuppMat.docx