# Influence of a Prenatal Fruit and Vegetable Prescription Program on Diet and Household Food Security in a Low-Income, Urban Community

## TL;DR

A prenatal program providing fresh produce prescriptions improved diet and food security for low-income pregnant women in Flint, Michigan.

## Contribution

This study evaluates the impact of a prenatal fruit and vegetable prescription program on diet and food security in a low-income urban population.

## Key findings

- Participants showed improved fruit and vegetable intake during early to mid-pregnancy.
- Household food security improved from mid-pregnancy to postpartum.
- Dietary intake declined between mid-pregnancy and postpartum.

## Abstract

A prenatal fruit and vegetable prescription program (FVPP) was introduced in Flint, Michigan to increase access to fresh produce during pregnancy. This program provides $15 fresh fruit and vegetable prescriptions to all prenatal patients during office visits, redeemable at a local farmers market and mobile market/food hub. The current study assessed changes in diet and food security throughout pregnancy among patients exposed to the prenatal FVPP.

This non-controlled longitudinal trial included prenatal patients at two low-income urban clinics presenting before 16 weeks’ gestation. Participants completed surveys to assess diet (one automated 24-hour dietary recall) and food security (US Household Food Security Module: Six Item Short Form - National Center for Health Statistics), with follow-up surveys at mid-pregnancy and postpartum.

A total of 118 pregnant women (mean age 26.32 ± 5.04 years, range 18–39 years) enrolled in the current study. Most identified as Black/African American (54.2%, n = 64), received Medicaid (66.9%, n = 79), and participated in The Special Supplemental Nutrition Program for Women, Infants, and Children or WIC (62.4% at midpoint). Participants received an average of 8.81 ± 2.30 fruit and vegetable prescriptions, with two-thirds redeeming at least one (66.9%, n = 79). Household food security worsened from baseline to midpoint (p = 0.076) but improved from midpoint to postpartum (p = 0.013). Participants reported notable changes in dietary behaviors at critical points during their pregnancy. Primarily, significant improvements in mean daily consumption of fruits and vegetables (p = 0.027); total vegetables (p = 0.015); and vegetables excluding potatoes (p = 0.030) were observed from early pregnancy to midpoint. Alternatively, mean daily intake of fruits and vegetables (p = 0.007) and total vegetables (p = 0.029) decreased between midpoint in pregnancy and the early postpartum period.

This study reveals the influence of a prenatal FVPP on diet and food security among prenatal patients living in one low-income, urban community. Results signal an urgent need for coordinated and comprehensive maternal supports that better address food and nutrition security during pregnancy and the early postpartum period.

Fruit and vegetable prescription programs have demonstrated positive impacts on food security, diet, and markers of health among adults and youth; still, little is known about their effectiveness during pregnancy, a vital period during which maternal nutrition and lifestyle choices influence the health of mother and child. Findings of this study suggest that fruit and vegetable prescriptions distributed during pregnancy are associated with notable improvements in dietary intake during critical stages of pregnancy; however, modifications are necessary to better coordinate and tailor nutrition resources to enhance perinatal outcomes.