Nourishing Tomorrow: Role of Medically Tailored Groceries in Addressing Food Insecurity During Pregnancy

Medically tailored groceries (MTG) generally involve fresh and shelf-stable grocery items to be prepared at home, selected by a nutritional professional based on a treatment plan and are typically picked up at a clinic, market, or pantry. This clinic-based market or pantry model (CB-MTG) is a growing approach adopted by health care systems in their effort to address food insecurity in their patient population, including University Hospitals of Cleveland (UH) and MetroHealth Medical Center (Metro), two of the three largest health systems in Cleveland, Ohio. Often offered to patients with food-related chronic conditions, CB-MTGs have shown to improve medication adherence, increase fruits and vegetable consumption and decrease HbA1c in people with diabetes. However, less evidence is available on the impact of CB-MTGs with food insecure pregnant individuals, where food insecurity has been strongly associated with prematurity and other negative birth outcomes.

While promising, the CB-MTG approach requires transportation, having the tools and equipment to prepare meals at home and some basic food preparation skills, all potential barriers for low-income pregnant individuals, especially younger parents-to-be or those already with children. The Greater Cleveland Food Bank and partners, seeking to address these barriers, recently developed a home delivered version of MTG (HD-MTG), offered to Medicaid-eligible pregnant individuals across the county, with promising results. The investigators seek to integrate these approaches into patient care for food insecure, pregnant women and test the effectiveness of these two approaches, alongside an additional intervention arm that adds supplemental nutrition and culinary education and support to the home-delivered approach (HD-MTG PLUS). These three approaches will be offered (via randomization) to 360 pregnant individuals (120 per arm) with food insecurity who are patients within UH and Metro's largest urban obstetric practices, each with direct electronic health record (EHR) referral systems to their "food as medicine" clinics/markets. Data are collected at baseline, near/at delivery and 6 months post-delivery. This study seeks to understand the unique contribution of each approach, as well as implementation and intervention uptake barriers, with the goal of building the evidence base of MTG interventions and making recommendations to providers and health systems seeking to address food insecurity and nutrient deficiencies during pregnancy.

• Birth Complications [Time frame: Perioperative/periprocedural]
• Prenatal Health Care [Time frame: From first documented prenatal visit until the baby's delivery date, assessed up to 9 months]
• Pregnancy Complications [Time frame: Perioperative/periprocedural]
• Gestational Diabetes Mellitus (GDM) [Time frame: Assessed up to 40 weeks of pregnancy]
• Attitudes toward Cooking and Food Preparation [Time frame: Change from baseline to delivery (assessed up to 40 weeks of pregnancy)]
• Attitudes toward Cooking and Food Preparation [Time frame: Change from baseline to 6-months post delivery]
• Cooking Efficacy [Time frame: Change from baseline to delivery (assessed up to 40 weeks of pregnancy)]
• Cooking Efficacy [Time frame: Change from baseline to 6-months post delivery]
• Cooking Frequency [Time frame: Change from baseline to delivery (assessed up to 40 weeks of pregnancy)]
• Cooking Frequency [Time frame: Change from baseline to 6-months post delivery]
• Dietary Quality [Time frame: Change from baseline to delivery (assessed up to 40 weeks of pregnancy)]
• Dietary Quality [Time frame: Change from baseline to 6-months post delivery]