Association Between Household Food Insecurity and Low Birth Weight: A Population-Based Case-Control Study

Background: Low birth weight (LBW) is a major public health issue associated with increased neonatal morbidity and mortality. This study aimed to examine the association between household food insecurity and LBW in Mashhad, Iran. Study Design: A population-based case-control study. Methods: This study involved 6294 mothers (3247 cases and 3247 controls) who visited healthcare centers affiliated with Mashhad University of Medical Sciences for term births between March 2019 and March 2022. Cases included women who delivered neonates weighing < 2500 g, while controls delivered babies >= 2500 g. Food security was measured using the validated Household Food Insecurity Access Scale. Logistic regression models examined the associations between food insecurity and LBW. Geographic information system techniques mapped LBW distribution in Mashhad. Results: Household food insecurity was significantly associated with higher odds of LBW (adjusted odds ratio [AOR] = 1.25, 95% confidence interval [CI]: 1.03, 1.53). Other risk factors included younger maternal age (AOR = 1.03, 95% CI: 1.01, 1.04), lower maternal education (AOR = 0.55, 95% CI: 0.43, 0.71), cesarean delivery (AOR = 1.70, 95% CI: 1.40, 2.06), and exposure to secondhand smoke (AOR = 1.68, 95% CI: 1.02, 2.75). Gestational diabetes demonstrated a protective effect (AOR = 0.37, 95% CI: 0.15, 0.91). Geographic mapping revealed that regions with higher food insecurity had elevated LBW prevalence. Conclusion: These findings underscore the importance of addressing food insecurity among pregnant women to reduce the risk of LBW and improve newborn outcomes.