Association of Food Deserts and COVID-19 Severity in Pregnancy as Reflected by Need for Hospitalization

Background: Socioeconomic disparities play an important role in disease epidemiology and outcomes in pregnancy.

Objective: The objective was to evaluate whether pregnant women with COVID-19 living in a food desert, are at increased risk of more severe disease reflected by symptoms at presentation and need for hospitalization.

Methods: In this retrospective observational study, the electronic medical records of all pregnant patients with documented SARS-CoV-2 infection were reviewed. Food deserts were defined by the USDA and the patient's residence was mapped on the Food Access Research Atlas to determine whether each patient lived within a food desert. Comparisons between those with documented symptomatic COVID-19 required hospitalization to those with documented COVID-19 without need for hospitalization were made using univariate analysis and multivariable logistic regression analysis.

Results: The cohort consisted of 129 pregnant patients with COVID-19, with 59.7% (n = 77) asymptomatic and 33.3% (n = 43) requiring admission due to disease severity. The majority were Hispanic (70.5%), and obese (median BMI 31.91 kg/m²), with 33.3% living in a food desert. Patients with disease severity necessitating admission were significantly more likely to reside in a food desert (46.5% vs. 27.9%, P 0.037, OR 2.246, 95% CI 1.048-4.814). No other significant differences were identified on univariate. Multivariable binary logistic regression modeling confirmed food desert residence to be the only independent predictor of more severe COVID-19.

Conclusion for practice: There is a strong association between living in a food desert and the development of symptomatic COVID-19 requiring hospitalization in pregnancy.