Dr. Olufemi Fabusoro is a researcher at the Renal and Cardiovascular Disease Laboratory, University of Illinois Urbana-Champaign, United States. In celebration of the World Diabetes Day on November 14, 2024, Fabusoro recently presented a seminar on the impact of food access/food insecurity on self-rated health, and diabetes self-efficacy among prenatal women with Gestational Diabetes in the context of the COVID-19 pandemic. In this interview with Sunday Aikulola, Fabusoro discussed how these factors affect women’s health and the national and global implications.
The world seems to still be engulfed with the COVID-19 pandemic, how did the pandemic impact pregnant women with Gestational Diabetes from a clinical nutritionist point of view?
The pandemic presented significant challenges, including: increased food insecurity, disruptions to food supply chains and economic hardships that led to difficulties in accessing nutritious food. Concerns about COVID-19 infection may have limited women’s access to routine prenatal care and diabetes management. The pandemic created significant stress and anxiety, which can negatively impact both physical and mental health.
Can you give a brief explanation of Gestational Diabetes Mellitus (GDM)?
In a lay man’s language, gestational diabetes is a type of diabetes that develops during pregnancy. It occurs when the body cannot produce enough insulin to meet the increased demands of pregnancy, leading to high blood sugar levels.
Why is GDM a concern?
GDM can increase the risk of complications for both mother and baby. For the mother, there is an increased risk of preeclampsia, premature birth, cesarean section, and increased risk of developing Type 2 diabetes later in life. For the baby, there is an increased risk of macrosomia (large baby), birth injuries, and an increased risk of developing Type 2 diabetes later in life.
The COVID-19 pandemic had a disproportionate impact on racial and ethnic minority populations, can you give us an overview of this implication on pregnant women with GDM?
COVID-19 affected access to food by nutritionally vulnerable individuals, particularly prenatal women with GDM. This may pose a negative effect on prenatal women’s confidence in choosing healthy food options to manage their diabetes (self-efficacy) and subjective perception of their health (self-rated health), ultimately impacting their health and overall wellbeing. Individuals with poor access to food have a two-fold higher risk of developing diabetes compared to those with secure food access. Our study therefore helped us to understand how food access affected self-rated health and self-efficacy among reproductive-age pregnant women with GDM in the context of the COVID-19 pandemic.
What were the key findings of your research?
The effect of food access or food insecurity on diabetes self-efficacy and self-rated health has not been well established, creating a significant knowledge gap. Also, there is a dearth of information on the association between food access, self-efficacy and self-rated health among prenatal women of reproductive age diagnosed with GDM in the context of the COVID-19 pandemic. My research found a strong connection between better food access and higher diabetes self-efficacy. This means that women with easier access to healthy and affordable food felt more confident in their ability to manage their diabetes. We also discovered that self-rated health played a crucial role in this relationship. Women who perceived their overall health better during the pandemic also reported higher diabetes self-efficacy.
Is food access or food insecurity a significant problem in Nigeria or the U.S.?
Yes, food access and food insecurity remain significant issues in Nigeria and the United States. In Nigeria, several factors contribute to this challenge such as economic instability and high poverty rates coupled with inflation, ongoing insecurity in parts of Nigeria, particularly in the North-east due to insurgency and banditry, infrastructure challenges, for example, poor transportation and storage facilities contribute to food waste, reducing availability in markets and raising food prices. Food access difficulties are encountered by more than 33% of households in the U.S. whose income falls below the federal poverty threshold, disproportionately affecting pregnant women with GDM. These vulnerabilities in food access have significant implications for national nutrition security. Food insecurity directly translates to inadequate dietary intake, impacting individuals’ nutritional status and increasing their risk of malnutrition and diet-related chronic diseases. Poor access to food is a pervasive issue for women, irrespective of their geographical location, as both urban and rural areas experience similar levels of vulnerability, with a heightened risk of contracting diseases due to food insecurity among pregnant women.
What are the uniqueness of your research to policy development especially among Nigerian pregnant women with diabetes?
This research delves into an understudied yet crucial area of maternal health, which can inform policy decisions regarding food assistance programmes, nutrition education initiatives, and healthcare services tailored to the needs of pregnant women with diabetes. The Nigerian government, alongside international organisations, has initiated various interventions like food assistance programmes and agricultural reforms. However, achieving food security requires sustained efforts to address structural issues like poverty, conflict, and climate adaptation. Nigeria still has a long way to go in terms of policies that would benefit patients with diabetes generally.
What are the implications of these findings for healthcare providers in Nigeria and the world in general?
The findings of the study can guide healthcare professionals to promote not only better diabetes management but also improved overall mental and emotional health of prenatal women with GDM. These findings emphasises the need for a multi-faceted approach to supporting pregnant women with GDM. Healthcare providers should screen for and address food insecurity, collaborate with nutritionists and social workers to identify and address food access challenges. They should also provide comprehensive mental health support and offer counseling services and support groups to address anxiety, depression, and other mental health concerns. It is important to empower women with diabetes self-management skills and provide comprehensive diabetes education and support programs that focus on building confidence and self-efficacy.
What are the next steps in this area of research?
My team and I are currently planning a study to better understand the specific barriers to food access faced by pregnant women with GDM. Additionally, we will be conducting a longitudinal study to examine the long-term impact of the pandemic on the health and well-being of this population.
What advice would you give to pregnant women diagnosed with GDM?
Pregnant women should prioritise self-care and engage in stress-reducing activities such as yoga, meditation, or spending time in nature. They should connect with other women with GDM by joining a support group can provide valuable emotional support and practical advice. Always share any concerns or challenges you are facing with your doctor, nurse, or dietitian. Make small, sustainable changes to your diet and incorporate regular physical activity into your daily routine.
