596: Is food insecurity during pregnancy associated with risk factors for maternal-to-child transmission of HIV?

Abstract

Previous studies have identified food insecurity as a risk marker for non-adherence to antiretroviral therapy (ART) and lack of viral suppression among non-pregnant adults living with HIV. Adherence to ART and viral suppression are critical in the perinatal context given the risk of maternal-to-child transmission (MTCT) of HIV. The objective was to examine the relationship between food insecurity during pregnancy and risk factors for MTCT. This retrospective cohort study included all pregnant women living with HIV who were cared for by a multidisciplinary obstetrics clinic between 2007 and 2018. Food access was universally assessed by a Licensed Clinical Social Worker during prenatal visits. Women were classified as food secure if they did not require resources beyond Women, Infants, and Children (WIC) Nutrition Program enrollment (for infant formula) and food insecure if they reported hunger or required additional resources, such as Supplemental Nutrition Assistance Program (SNAP) or food pantries. Factors associated with MTCT included missed prenatal visits, self-reported missed ART doses, number of weeks until viral suppression, undetectable viral load at 36 weeks, viral load at delivery, and gestational age at delivery. Associations between food insecurity and these MTCT risk factors were examined via bivariable and multivariable analyses. Of the 173 pregnant women living with HIV who were assessed for food access, 14% (n=25) were food insecure. In bivariable analyses, food insecurity was not associated with number of prenatal visits, time to viral suppression, or viral load at 36 weeks or delivery. However, women who experienced food insecurity during pregnancy were more likely to miss ART doses and deliver preterm (Table). After controlling for potential confounders (Figure), these findings persisted (Table). Food insecurity is common among pregnant women living with HIV and is a risk marker for missing ART doses or delivering preterm. Future research on interventions to minimize food insecurity as a means to augment prevention of MTCT efforts are warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)