The Role of Medically Tailored Groceries in Mitigating Food Insecurity and Improving Pregnancy Outcomes through Clinic-Community Partnerships

Medically tailored groceries (MTG) generally involve fresh and shelf-stable unprocessed grocery items to be prepared at home, selected by a nutritional professional based on a treatment plan and are typically picked up at a clinic, market, or pantry. This clinic-based market or pantry model (CB-MTG) is increasingly being adopted by health care systems in their effort to address food insecurity in their patient population, including University Hospitals of Cleveland (UH) and MetroHealth Medical Center (Metro), two of the three largest health systems serving Northeast Ohio. Often offered to patients with food-related chronic conditions, CB-MTG have shown to improve medication adherence, increase fruits and vegetable consumption and decrease HbA1c in people with diabetes. However, less evidence is available on the impact of CB-MTG with food insecure pregnant patients, where food insecurity has been strongly associated with prematurity and other negative birth outcomes. While promising, the CB-MTG approach requires transportation, having the tools and equipment to prepare meals at home and some basic food preparation skills, all potential barriers for low-income pregnant patients, especially younger parents-to-be or those already with children. The Greater Cleveland Food Bank and partners, seeking to address these barriers, recently developed a home delivered version of MTG (HD-MTG), offered to low-income pregnant patients across the county, with promising results. We seek to integrate these approaches into patient care for food insecure, pregnant women and test the effectiveness of these two approaches, alongside an additional intervention arm that adds supplemental nutrition and culinary education and support to the home-delivered approach (HD-MTG PLUS). These three approaches will be offered (via randomization) to 360 pregnant patients (120 per arm) screened for food insecurity from within UH and Metro’s largest urban obstetric practices, each with direct EHR referral systems to their “food as medicine” clinics/markets for those screened food insecure. Data are collected at baseline, near/at delivery and 6 months post-delivery. This study seeks to understand the unique contribution of each approach, as well as implementation and intervention uptake barriers, with the goal of building the evidence base of MTG interventions and making recommendations to providers and health systems seeking to address food insecurity and nutrient deficiencies during pregnancy.