Objectives: The objectives of this study are to: (1) document prevalence of food insecurity among pregnant adolescents; (2) determine if food insecurity is associated with adverse birth outcomes (i.e., lower birth weight, earlier gestational age) among their newborns; and (3) examine whether depressive symptoms, anxiety, nutrition and/or weight gain mediate these associations.

Methods: Pregnant adolescents (14-21 years old; N-881) in prenatal care at community hospitals and health centers in New York City completed a health and psychosocial survey during second and third trimesters of pregnancy. Birth weight and gestational age were recorded from medical records.

Results: Over one-half of the adolescents reported food insecurity. Path analyses demonstrated that food insecurity was associated with lower birth weight and earlier gestational age. Depressive symptoms mediated these associations.

Conclusions: Pregnant adolescents experience high rates of food insecurity. Those who were food insecure experienced more depressive symptoms, which in turn predicted adverse birth outcomes. Programs and policies should target these vulnerable children to stem the "multi-generational" effects of food insecurity.

Key Take Away Points

  • Pregnant adolescents experience alarming rates of food insecurity: more than one-half, in this urban sample.
  • Food insecurity was associated with lower birth weight and earlier gestational age; depressive symptoms mediated these associations.
  • Results have implications for inter-generational effects of food insecurity on pregnant adolescents and their children.

Author Biography

Stephanie A. Grilo is a graduate student in Sociomedical Sciences at Columbia University and a research associate at Yale University. Her research focuses on systematic inequalities and health disparities affecting minority groups, women and children. Valerie A. Earnshaw is an Instructor in Pediatrics at Harvard Medical School and Associate Research Scientist in the Division of General Pediatrics at Boston Children’s Hospital. She studies associations between stigma and health inequities. Jessica Lewis is the Deputy Director of Connecticut Women’s Health Project at Yale School of Public Health. Her research is focused on maternal and child health, with a particular focus on models of prenatal care and organizational change. Emily Stasko is a graduate student in Clinical Psychology at Drexel University. Her clinical and research interests are in sexual health and intimate partner relationships. Urania Magriples is Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine and a clinician in Maternal-Fetal Medicine. Her research focuses on innovative models for delivery of obstetric care domestically and globally. Jonathan Tobin is President/CEO of Clinical Directors Network (CDN), Co-Director of Community Engaged Research at Rockefeller University, and Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine. CDN conducts practice-based comparative effectiveness research in underserved communities. Jeannette R. Ickovics is Professor of Epidemiology and Public Health and of Psychology at Yale University. Her research investigates the interplay of complex biomedical, behavioral, social and psychological factors that influence individual and community health, and is noted for its methodological rigor and community engagement.


This project was supported by grants from the National Institute of Mental Health (R01MH074399, R01MH07394, T32MH020031). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.