Food Justice and Reproductive Health

Carbohydrates are broken-down dietary sugars, such as glucose, that enter the bloodstream during digestion. In response to these sugars in the blood, the body releases insulin to decrease blood sugar. Diabetes can develop when the body stops responding to insulin–insulin resistance–which can cause blood sugar levels to increase past healthy levels. Complex carbohydrates, such as those found in whole grains, brown rice, and legumes, are considered “good” because they do not raise blood sugar quickly. On the contrary, simple carbohydrates, such as those in white bread, rice and pastas that are not whole grain, and sugary drinks, are considered “bad” because they do raise blood sugar quickly. The prevention and management of diabetes is rooted in preventing insulin resistance by limiting simple carbohydrate intake to prevent significant and rapid increases in blood sugar. 

However, the amount and types of carbohydrates consumed are directly impacted by both socioeconomic and racial factors. According to Karen Throsby, PhD, sugar moderation is the hallmark of economic privilege. Products that are high in sugars are often cheaper and more accessible to low-income families. There is a relationship between race, poverty, neighborhood location, and diabetes prevalence, as shown in a study by Darrell J. Gaskin, PhD. Poverty and residence in low-income neighborhoods increased the odds of having diabetes for all study participants; however, Gaskin also found that Black people were at higher risk of having diabetes, and that Black women were at higher risk for gestational diabetes when compared to their white counterparts. 

Gestational diabetes is a type of diabetes that develops during pregnancy. This disease is one of the major reproductive illnesses that disproportionately impacts Black birthing people. These impacts have wide-reaching consequences for pregnant people. A finding that is supported by Akilew Awoke Adane, PhD, who also noted that gestational diabetes may in turn contribute to an increased risk for:

• Preeclampsia
• Miscarriage
• Stillbirth
• Development issues in children 

To add to this, about 50% of people who develop gestational diabetes develop Type 2 diabetes later on. Spreading awareness of the reproductive health benefits of low-sugar diets may help to address the disparity in the pregnancy and birth outcomes affecting low-income Black women.

In addition to containing excessive sugar, diets most accessible to food-insecure households are often high in salts and fats. These unhealthy diets can lead to an increased risk for cardiovascular disease (CVD), particularly hypertension as indicated by Alexandra Luttrell, MPH. Hypertension is a CVD characterized by high blood pressure that causes increased risk for:  

• Heart attack or stroke
• Aneurysm
• Heart failure
• Kidney problems
• Eye problems
• Metabolic syndrome
• Changes in memory or understanding
• Dementia

Food insecure individuals are more likely to be hypertensive and less likely to have their high blood pressure under control. The correlation between income and hypertension supports the need to consider food-insecurity when addressing rates of hypertension in low-income communities. 

Low-income communities are also more frequently subjected to living in areas with limited access to food, which raises their risk of CVD and restricts the ability of residents to cut high-salt and high-fat foods out of their diets. Research from the American Heart Association led by Heval M. Kelli, MD. found that residents with low access to healthy foods had a higher 10-year risk of CVD, particularly for hypertension. In addition, majority Black neighborhoods are more likely to have more fast-food restaurants, fewer supermarkets, fewer healthy food options, and worse walking environments—all of which are factors that can increase CVD risk. 

These disparities in accessing healthy foods that affect CVD risk also affect reproductive health outcomes in pregnant people including preeclampsia: high blood pressure during pregnancy. Preeclampsia, as with all forms of hypertension, can be directly impacted by diet among other factors. Preeclampsia can be caused by excessive salt consumption while pregnant. Monitoring and controlling salt intake as part of prenatal care can regulate blood pressure changes throughout pregnancy. In addition, salt consumption during pregnancy can affect levels of the hormone aldosterone, which Anna Birukov, PhD, found can increase the risk for preeclampsia and low fetal birth weight. However, salt is not the only nutrient that can affect the risk of this serious pregnancy complication. 

A prenatal diet rich in excess fats may also elevate the risk of preeclampsia. Pregnant women whose fat consumption exceeds the recommended amounts are at higher risk for both preeclampsia and gestational diabetes, states Amrita Khaire, PhD. Low-income Black women are at higher risk of developing preeclampsia, due to racial and ethnic disparities in access to healthy food access, particularly access to foods low in salt and fats. Black women have a 45% increased chance of developing preeclampsia when compared to other racial and ethnic groups as research by Anum Minhas, MD, MHS, shows. These results were partially attributed to socioeconomic factors impacting healthcare access and dietary compositions. 

In addition, maternal fat intake can directly impact infant health outcomes. Dr. Khaire’s research found that fat consumption far below healthy amounts in pregnant women was linked to preterm birth and delayed infant growth. Conversely, food insecurity can also cause an overconsumption of foods high in fat. Total maternal fat consumption above recommended levels can be associated with decreased infant regulation, the ability for infants to regulate their emotions in response to their environments as indicated by Hanna C. Gustafsson, PhD. 

Furthermore, daily maternal fat intake, as Natalie Damen, LD, found, is correlated with infant body fat, which comes from an association between maternal fat consumption and the circulation of maternal fat in the blood. Maternal blood is directly connected to the placenta allowing maternal fat circulation to impact infant health and increasing infant risk for obesity. 

Sufficient vitamin and mineral intake is necessary for overall health, including reproductive health. Deficiencies in several vitamins, notably selenium, vitamin D, vitamin C, and folic acid, have been linked to adverse reproductive health outcomes in particular. 

Selenium is a mineral naturally found in many foods. It is a building block of many types of proteins, and its sufficient intake can affect reproductive health in a number of ways including:

• Hormone balance: Women with high enough levels of selenium had normal levels of thyroid hormones, which supports thyroid function as indicated by a study by Pierre Hofstee, MD, PhD. A healthy thyroid is vital for the proper functioning of the female reproductive system which can increase the chances of positive reproductive health outcomes.
• Maternal health: According to María Luisa Ojeda, PhD, adequate selenium intake can help prevent some adverse pregnancy outcomes, including miscarriages, premature birth, infertility.
• Fetal and infant health: Dr. Ojeda also found that Selenium was linked to normal fetal development as well as healthier breast milk for the infant. 

Vitamin D is another important nutrient for reproductive health. It is crucial to many body processes including calcium and phosphorus absorption. Aside from being important for healthy bone growth, cancer prevention, and inflammation control, the WHO and Jennifer Tamblyn, MD, MSPH, found that proper levels of vitamin D can lower the risk of adverse reproductive health outcomes such as:

• Pre-eclampsia
• Gestational diabetes
• Miscarriage
• Preterm birth

Black mothers and their newborns carry a higher burden of vitamin D deficiency compared to their white counterparts. Lisa Bodnar, MPH, PhD. explains that Black women are at higher risk for vitamin D deficiency due to the interference of melanin in vitamin D absorption. Melanin, or skin pigmentation, absorbs the UV radiation that initiates the synthesis of vitamin D. Healthcare providers treating pregnant people and those who plan to become pregnant should consider vitamin D supplements to improve reproductive health outcomes. 

Vitamin C is an antioxidant integral to preventing damage to cells; thus, it is another nutrient vital to prenatal health. This nutrient is known to prevent the onset of cancer, CVD, and other chronic illnesses. In addition, according to James Adams, PhD, prenatal vitamin C deficiency is also linked to:

• Premature rupture of membranes (PROM) 
• Preterm birth due to PROM
• Preeclampsia 
• Urinary tract infections

Folic Acid is a form of folate, which encompasses different forms of vitamin B. Folate impacts several aspects of health. It is involved in operations impacting cell growth, brain health, inflammation, and red blood cell formation. During pregnancy, folate is involved in developmental processes for the embryo and the structures connecting the mother and fetus. Because folate is important for healthy red blood cell formation, it plays a major role in both maternal and infant health. To look at the maternal and infant health risks of folic acid deficiency, Madhusadan Dey, PhD, researched pregnancy outcomes amongst women and found that decreased folic acid levels were correlated with risks for the following: 

• Miscarriages 
• Anemia during pregnancy 
• Preterm delivery  

Folic acid intake and its connection to infant health is becoming a higher priority within the healthcare community. In 2023, the US Preventive Services Task Force published a recommendation to begin folic acid supplementation at least one month before pregnancy to prevent neural tube defects, malformations of the spinal cord, a health outcome that has been connected to maternal folic acid deficiency in numerous studies. 

Additionally, since folic acid has been connected to preeclampsia, Thelma Patrick, PhD, researched racial differences in folic acid levels and related health outcomes. Black women were found to have lower folic acid levels compared to white women, and scientists discovered that these findings are connected to the higher rates of preeclampsia Black women face. Folic acid supplementation is an important part of preconception and prenatal care and is necessary for optimal pregnancy outcomes.