Screening Food Insecure during Pregnancy: Pilot Testing an Effective Brief Tool for Use in an Australian Antenatal Care Setting

The purpose of this research is: (1) to determine the prevalence of food insecurity among pregnant people using the 10-, 6-, and 2-item iterations of the USA Household Food Security Survey Module (HFSSM) and the single item measure, and (2) identify an appropriate combination of questions that could be used to identify food insecurity in a clinical setting for a population of people who are pregnant in Australia. Cross-sectional survey collecting self-reported data from pregnant people in Australia (open May 2021 to March 2022). Survey included demographic characteristics, including income/welfare use, education, age, pregnancy information, household size and composition, and two measures of food insecurity. In total, 303 participants were included in the analysis. Sensitivity and specificity of the various combinations of questions were conducted. Food insecurity was estimated using the single item, and the 2-item, 6-item, and 10-item versions of the HFSSM, food insecurity was 6.2%, 11.4%, 11.7%, and 14.3% respectively. Respondents who were living in households that were food insecure answered affirmatively to question one, two, or three of the HFSSM, with the combination of questions one and three showing the best sensitivity and specificity for the whole sample, as well as for those who have characteristics likely to lead to food insecurity. Further testing of the 2-items, comprised of items one and three from the HFSSM, need to be conducted with a larger and more diverse sample to determine if this is an appropriate screening tool in an antenatal clinical setting to determine food insecurity during pregnancy.