Associations Between Household Food Insecurity and Participation in Nutrition Assistance Programs, and Ultraprocessed Food Consumption and Diet Quality Among Pregnant Women in NHANES, 2001-2018.

Abstract

<b>Objectives.</b> To examine associations between (1) food insecurity and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP), and (2) ultraprocessed food (UPF) consumption and Healthy Eating Index-2020 (HEI) score among US pregnant women. <b>Methods.</b> We analyzed data from pregnant women (n = 1286) across 9 waves of National Health and Nutrition Examination Surveys, from 2001 to 2018. We assessed UPF consumption, as percentage of energy from Nova Group 4 classification, and HEI. Multivariable regressions estimated associations of food insecurity and WIC or SNAP participation with UPF consumption and HEI. <b>Results.</b> Food insecurity affected 20% of women and was associated with lower HEI (B = -3.8; SE = 1.4; <i>P</i> = .01) but not UPF consumption. UPF consumption did not differ by WIC or SNAP participation status (<i>P</i> > .05). WIC participants had higher HEI while SNAP participants had lower HEI (<i>P</i> = .01). <b>Conclusions.</b> Food insecurity was linked to lower prenatal HEI but not UPF consumption. WIC may improve otherwise low prenatal HEI; unchanged UPF consumption, irrespective of nutrition assistance beneficiary status, warrants public health and nutrition education strategies to reduce UPF consumption and scale access to affordable, less-processed, nutritious foods. (<i>Am J Public Health</i>. 2026;116(7):971-980. https://doi.org/10.2105/AJPH.2026.308507).