Funding will provide one of the first comprehensive, rigorous studies of 'medically tailored' groceries as an approach to reduce food insecurity and improve maternal and baby health outcomes
With a new five-year, $3.8 million grant from the National Institutes for Health, researchers at Case Western Reserve University-in partnership with the Greater Cleveland Food Bank, MetroHealth Medical Center (Metro) and University Hospitals of Cleveland (UH)-will provide health and nutrition support for low-income pregnant women in an expanded Nourishing Beginnings program, now called Nourishing Tomorrow.
Not having enough healthy food to eat during pregnancy can lead to health disparities for both moms and babies. So some healthcare systems offer medically tailored groceries (MTG)-foods chosen by a nutritional professional and available to be picked up for several weeks or months during pregnancy-to address this.
While promising, the traditional approach to receiving MTGs requires transportation, having the tools and equipment to prepare meals at home and some basic food-preparation skills.
Elaine Borawski, the Angela Bowen Williamson Professor of Community Nutrition at the Case Western Reserve University School of Medicine, and Alissa Glenn, director of community health and nutrition at the Greater Cleveland Food Bank, will lead the study of 360 food-insecure pregnant patients recruited from UH and Metro.
They hope to determine if MTGs-either through home delivery or picked up at a medical center and providing nutrition and cooking education-can improve overall health for mothers and babies.
"Food security is one of the most foundational social needs, with a growing consensus that food and nutritional security are instrumental in the prevention and treatment of the most prevalent health conditions," Glenn said. "As a result, a spectrum of food-is-medicine (FIM) interventions have been developed, integrating food access with clinical care and support. These include government programs, such as WIC and SNAP, as well as newer approaches, ranging from produce prescription programs to medically tailored meals and groceries."
Three types of MTGs will be offered randomly to study participants: the traditional model, which requires pickup from a clinic or market; those delivered directly to the participant's home; and MTGs delivered to the home, with participants offered personalized supplemental nutrition and culinary education.
Data will be collected when deliveries start, at or near the baby's delivery and six months postnatal. The researchers want to learn whether the program will result in healthier babies. If successful, the research may provide evidence for the cost of MTGs to be covered by Medicaid, Medicare and other insurance programs. Once a funding source is identified, the Greater Cleveland Food Bank would offer the program to health systems, they said.
While growing and promising, to date, the evidence for FIM interventions has been sparse due to studies being limited by non-randomized designs, sample size and lack of clinical health outcomes. Also, few FIM approaches have targeted high-risk pregnancies, despite the critical need for improved nutrition during pregnancy.
"Pregnant individuals faced with food insecurity are twice as likely to deliver a premature baby," Borawski said. "For over 30 years, Cuyahoga County has had one of the highest infant mortality rates in the nation, with prematurity being the largest contributing factor. Our goal with this study is to link MTGs to health outcomes, allowing us to provide recommendations for healthcare-community partnerships and integrate FIM approaches into patient care."
