Date of Award

Fall 2025

Project Type

Thesis

Program or Major

Nutritional Sciences

Degree Name

Master of Science

First Advisor

Noereem Z Mena

Second Advisor

Maria C Dao

Third Advisor

Sherman Bigornia

Abstract

Background: Dietary intake during pregnancy and postpartum plays a critical role in the short- and long-term health outcomes of both mother and child. National data indicates that nutrition interventions to improve diet quality in US prenatal populations are of public health importance. While previous research has explored food insecurity and maternal diet quality, there is limited research on the relationship between multiple social and structural determinants (experiences with discrimination, food security status, and WIC participation), dietary intake and diet quality in perinatal populations. For targeted nutrition interventions to improve diet quality, more research is needed to understand the relationship between structural and social determinants and diet quality in perinatal populations in New Hampshire.

Objective: To examine associations between diet quality and experiences with discrimination, food security status, WIC participation, and area of residence among pregnant and postpartum women in New Hampshire.

Methods: A cross-sectional survey of 51 women (84% postpartum, ≤3 years) was conducted. Participants completed a sociodemographic questionnaire, the short Healthy Eating Index (sHEI), the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the USDA 6-item Food Security Module. Non-parametric tests were conducted for all inferential analyses after a Shapiro-Wilk’s test confirmed that the data was not normally distributed (p

Results: Participants were primarily non-Hispanic White (72.5%), US-born (78.4%), married (84.3%). Nearly all respondents reported “no” to experiencing any form of discrimination during healthcare visits, 60% reported never personally experience discrimination, however, 86% agreed that racial or ethnic discrimination against non-white groups happens often/sometimes. Forty percent reported residing in suburban areas, 32% reported rural, and 28% reported urban/metro. The median total sHEI score was 53.5 (IQR = 11.4) out of 100 total possible points. There were no significant differences in overall sHEI scores by food security status (High vs. MLV.L) (p = 0.11), or area of residence (p = 0.66). Compared to participants who reported high food security status, intake of fruits and vegetables was significantly lower for participants who reported MLV.L food security (p < 0.05). Urban and rural residents had higher sHEI subcomponent dairy scores than suburban residents (p.adj = 0.02).

Conclusion: Diet quality was overall suboptimal, and participants with MLV.L food security demonstrated particularly lower intakes of fruits and vegetables. Trends in subgroup differences may suggest potential disparities.

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