There is a need to continue to understand, nutrition, and overall health and wellbeing of athletes during pregnancy and postpartum. This study aimed to explore nutritional perceptions, needs, preferences, and concerns of female athletes in the United Kingdom (UK) and Republic of Ireland (ROI) during pregnancy and postpartum. An exploratory cross-sectional online survey was conducted between April and May 2024 among athletes ≥ 18 years who had experienced a pregnancy while competing (or retiring due to pregnancy) within the last eight years. Athlete level is defined from a performance calibre framework; “elite” encompass Tiers 3 (Highly Trained/National Level), 4 (Elite/International Level) and 5 (World Class) and “active non-elite” encompass Tiers 1 (Recreationally Active) and 2 (Trained/Developmental). Descriptive analyses were conducted for the full sample and stratified by pregnancy status and athlete level. Group differences were assessed using chi-square and McNemar’s test. Two hundred eighty-seven athletes (34.7 ± 3.8 years) from 48 different primary sporting types and activities completed the survey. 44

Food insecurity (FI) has increased in recent years due to economic shifts and rising food prices, with 13.6% of UK households experiencing FI, 47% including children in 2024. Following PRISMA guidelines, this systematic review with narrative synthesis explored the impact of UK interventions addressing FI for children, families, and pregnant women. Seven databases and two clinical trial registers were systematically searched for articles published between 2008-November 2023 (rapid search November 2023-February 2026). Peer-reviewed intervention studies were eligible if they were conducted in the UK, had an experimental design, targeted at least one FI pillar (accessibility, utilisation, availability, and stability) and if most participants were children aged 0-11 years, families with at least one child 0-11 years, or pregnant women. 18,225 articles were identified (rapid search identified 5,514); 11 intervention studies were included (rapid search n = 2). Types of interventions included cooking interventions (n = 4), free school meals (n = 3), holiday clubs (n = 2), supermarket vouchers (n = 1), and food bags (n = 1). Food availability was targeted in seven studies, food accessibility and utilisation in five, and food stability in one, one study included FI as an outcome. The interventions demonstrated barriers and facilitators to inform future intervention development. Most studies were considered serious or critical risk of bias. A lack of high-quality interventions addressing FI were identified. The additional studies reflected the evidence from the original studies. Government policies and funding are needed to relieve FI. Research needs to co-develop acceptable interventions and evaluate their effectiveness to reduce FI among families.

INTRODUCTION:Food insecurity, when individuals do not have sufficient access to food, has rapidly increased in high-income countries (HICs) since the 2008 global financial crisis. Women are particularly at risk of experiencing food insecurity, and during pregnancy, this can have detrimental physical and emotional health implications. OBJECTIVE:To synthesise qualitative research exploring pregnant women's experiences of food insecurity in HICs (PROSPERO 2023 CRD42023404774). METHODS:Systematic review of qualitative literature reporting data on women's experiences of food insecurity. Six databases (MEDLINE, Embase, Web of Science, CINAHL, ASSIA, Scopus) and grey literature sources were searched, followed by forwards and backwards citation chaining for all included studies. Screening of titles, abstracts and full-texts, data extractions and quality appraisals (using the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist) were completed in duplicate. Certainty in the evidence was evaluated using GRADE-CERQual. PARTICIPANTS/SETTING:Food-insecure pregnant and postnatal women, in HICs, since the global financial crisis of 2008. MAIN OUTCOME MEASURES:Experiences of food insecurity during pregnancy. ANALYSES:Thematic synthesis using NVivo14 to code data. Hand-drawn thematic maps were used to group codes into sub-themes and overarching themes. Coding and hand-drawn thematic maps were combined to create a final visual summary of analytical themes. RESULTS:Searches resulted in 32,685 studies, and 32 were included (n = 20 North America, n = 10 Europe, n = 2 Australia). Findings identified three overarching themes: (1) barriers in access to food, (2) impact on physical and mental health, and (3) established individual, informal and statutory coping strategies. Women frequently discussed barriers to accessing fresh fruit and vegetables, resulting in poorer quality diets. Whilst qualitative data extracted precluded any direct pregnancy versus pre-pregnancy comparison, pregnancy appeared to exacerbate the experiences of food insecurity for women. The future arrival of a newborn created additional financial concerns along with worries over nutritional needs. Reliance on others was a recurrent strategy for pregnant women to mitigate the impact of food insecurity. The GRADE CERQual assessment showed moderate to high confidence in all findings. CONCLUSIONS:The findings of this qualitative review-the first to focus on experiences of food insecurity during pregnancy across HICs-show that women are experiencing substantial impacts from food insecurity during this critical life course stage. Review findings emphasise the need for co-ordinated screening and interventions that aim to support women to mitigate the impacts of food insecurity and its underlying causes to improve postpartum health and wellbeing.

Since late 2021, the UK has been experiencing a cost-of-living crisis which has increased the number of households vulnerable to food insecurity. Food insecurity is a contributing factor for poorer mental health, higher rates of obesity and lower diet quality. Improving cooking skills and food-related practices may alleviate the experience of or severity of food insecurity. However, confidence in adopting cooking skills and food-related behaviours amongst different food security statuses are unknown. This primary research aimed to investigate the relationships between food insecurity, mental wellbeing, dietary quality, and food behaviours in the UK.A nationally representative cross-sectional survey was undertaken with 1493 adults in April 2023. Participants were recruited using a market research company. Data on food insecurity, mental wellbeing, diet quality and food behaviours were collected, using validated measures where available. Data analysis consisted of chi-square tests of homogeneity, Kruskal-Wallis H tests and hierarchical multiple regression modelling with adjustment of relevant covariates.Within the sample, 49.9% were male, mean age was 44.7 years (SD 16.3), 35.9% were classified into groups of with low (22.2%) or very low (13.7%) food security. Analyses indicated that low or very low food security was significantly associated with greater proportions of females, lower-income individuals, and those of non-white ethnicity (p < 0.05). These groups also reported poorer mental wellbeing and lower daily fruit and vegetable intake (p < 0.05). Adjusting for food insecurity and income, food engagement and cooking confidence were independently associated with higher mental wellbeing and better dietary intake (p < 0.001), models explained 28.5% and 16.4% of variance, respectively. Notably, individuals with marginal food security demonstrated lower confidence in changing food-related behaviours than those with very low or high food security.This study reveals high levels of food insecurity among UK adults, whilst also highlighting its association with poorer mental wellbeing and diet quality, particularly among higher risk groups. These findings emphasise the urgent need for implementing programs to improve confidence in cooking skills and food-related behaviours amongst those marginally food insecure, alongside calls for changes to upstream determinants of food insecurity to support reducing these dietary and health disparities.

Objectives To assess the content and frequency of advice community pharmacists (CPs) provide to pregnant women with nausea and vomiting, their confidence in providing advice, and their knowledge of the safety of medication used to manage the condition.Methods An online questionnaire of closed- and open-ended questions was distributed to CPs in the UK in May 2023. Closed-ended questions were analysed quantitatively, and conventional content analysis was utilised for open-ended responses.Key findings One hundred and eighty-one respondents completed the questionnaire, 24 responses were excluded, leaving data from 157 available for analysis. The majority (90.4%) of participants reported having experience in providing advice on nausea and vomiting with varying levels of confidence. Advice provided included using over-the-counter products, lifestyle modifications, reassurance, medication advice, and referring to other healthcare professionals. Knowledge of first-line antiemetics considered safe in pregnancy varied; cyclizine was correctly identified as safe during pregnancy by 57.3%, followed by 37.6% for promethazine and 31.2% for prochlorperazine. Self-reported confidence and having experience providing advice were related to higher medication safety identification rates. Five percent of participants reported previous training on the condition, while 70% reported wanting further education, preferably delivered via an online medium.Conclusions This study showed that although 90% of CPs provide advice on nausea and vomiting in pregnancy, their medication safety knowledge varied. The majority of CPs reported wanting further education that would ensure women could access reliable information and evidence-based advice to optimise management of the condition.

This scoping review examined how the COVID-19 pandemic and cost-of-living crisis have influenced domestic cooking and food-related behaviours. Following PRISMA-ScR, a systematic search across five databases and grey literature sources identified 4955 records. After screening, 98 studies published between 2020 and 2024 were included. Most studies were conducted in the UK (22.4 %) and USA (18.4 %) and employed cross-sectional (94.9 %) and quantitative (73.5 %) methods. The review identified widespread increases in home cooking, with 50-78 % of participants reporting greater cooking frequency. Changes in food shopping were also prominent, including reduced in-person visits (reported by 40-74 % of participants) and increased online grocery use (25-61.8 %). Budgeting behaviours adapted to financial constraints, with many households reducing the quality and quantity of food purchased, substituting fresh with shelf-stable options. Improvements in hand hygiene were widely reported (74-90 %); however, unsafe practices such as consuming expired foods or mishandling leftovers, remained common. Only 4.1 % of studies received a positive quality rating, with frequent use of non-validated tools and self-reported measures. Future research should employ longitudinal designs to assess the sustainability of these behaviours. Structural policy actions are needed to ensure access to affordable, nutritious foods and support sustainable food practices during ongoing economic challenges.

An increasing number of female athletes are navigating an athletic career alongside pregnancy. Limited qualitative research has investigated the experiences of elite athletes in the United Kingdom (UK). This study aimed to explore the experiences of elite athletes in the UK as they navigated pregnancy, employing a socio-ecological framework to inform future research and policy recommendations on sport participation during pregnancy. A descriptive qualitative study design, adopting a relativist ontology and constructivist epistemology, was implemented. Semi-structured online interviews were conducted with elite athletes ≥ 18 years old, who resided in the UK, and who trained and/or competed at the highest level of their sport prior to and/or during pregnancy. Interviews were recorded, transcribed and analysed using reflexive thematic analysis. Eleven athletes (mean age 31 ± 3 years) from nine team and individual sports participated in the study. Four key themes were developed: (1) From the Podium to Parenthood: Institutional versus Individual Influence on Reproductive Planning; (2) Is My Career Over? Micro Level Support versus Macro Level Doubt and Worry; (3) Athlete to Mother: Internal Conflict to Community Role Model; (4) Navigating the Bump: Individual Drive to Tackle Systemic Gaps. Findings highlight the complexity female athletes face when navigating pregnancy, motherhood and elite sport. There is a need for high-quality research focusing on preconception and pregnancy-specific training and nutrition modifications for elite athletes, particularly regarding nutrient intake and supplementation. Additionally, efforts to improve the translation of evidence-based research into practical applications remain essential.

Gestational diabetes mellitus (GDM) is associated with short- and longer-term adverse outcomes for both mother and child. The success of randomised controlled trials (RCTs) assessing interventions to prevent GDM depends in part on participant adherence to and acceptability of the intervention. A review of the nested-qualitative components of antenatal RCTs to prevent GDM is lacking. This qualitative systematic review aimed to evaluate the experiences of pregnant women at higher risk of developing GDM who took part in preconception and/or pregnancy interventions which aimed to reduce GDM. Electronic databases (MEDLINE, EMBASE, Cochrane Library), and reference and citation lists were searched up to February 2025. Studies were eligible if they included qualitative research methods to examine the experiences of pregnant women following an intervention to reduce GDM. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, and the Critical Appraisal Skills Programme (CASP) qualitative checklist was used to assess the quality of the studies. Of the 38,812 studies initially identified, 102 trials were screened for eligibility, and four met the inclusion criteria and were included. All were pilot RCTs using semi-structured interviews in high-income countries (UK n = 3, USA n = 1). Data were synthesised into three themes: (1) acceptability of the interventions, (2) adherence to the interventions, and (3) perceived change in knowledge, attitude and behaviour. Acceptability of interventions was influenced by awareness of GDM, extra support and antenatal care, and natural pharmacological supplements. Adherence to interventions was facilitated by the intervention content and delivery. Perceived change in knowledge, attitude and behaviour was facilitated by intervention specific components and perceived improvements in health. This review identified factors influencing adherence and acceptability of interventions for pregnant women at high risk of GDM. It also highlighted a lack of embedded qualitative studies exploring women’s experiences of participating in antenatal interventions. The findings suggest that improving the design and implementation of pregnancy interventions requires greater attention to participants’ experiences and support systems. This study highlights the need for nested qualitative studies in RCTs to improve acceptability and adherence to pregnancy interventions.

OBJECTIVES:Elite athletes are more commonly returning to sport after pregnancy. Whilst research and policies to support athletes after pregnancy are increasing, understanding the lived experiences of United Kingdom (UK) elite athletes as they return to sport remains limited. This study aimed to examine the experiences and perspectives of UK elite athletes from a range of sports on the postpartum period and the return to sport. DESIGN:A descriptive qualitative approach utilising semi-structured interviews. METHODS:Online interviews were conducted via Microsoft Teams with elite athletes living in the UK, who trained and/or competed at the highest level of their sport prior to and/or during pregnancy. Data were analysed using reflexive thematic analysis. RESULTS:Eleven athletes participated in the study. Four key themes were generated: (1) Navigating Mother-Athlete Identity, (2) Preparation to Return to Sport, (3) Personal Support and Inspiration, and (4) Systemic Support. Findings showed that UK athletes must navigate both identity shifts and practical challenges in their return to sport postpartum. Observing other female athletes make this transition provided encouragement to the participants. Support from the athlete's immediate community and broader sporting organisations played a critical role. Access to specific supports and resources, such as pragmatic return-to-sport timelines, nutritional guidance, and maternity leave policies that safeguarded funding, positively impacted the postpartum return to sport. CONCLUSIONS:High-quality research to continue to inform guidelines for elite athletes returning to sport and developing maternity leave policies specific for all athletes in the UK need to be prioritised. This is to ensure that athletes are properly supported during postpartum and can resume their careers.

Food insecurity is a well-established obesity driver. Less is known about food insecurity during pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG), and nutrition. Searches included seven databases, gray literature, references, citations, and contacting authors. Observational studies reporting data from January 1st, 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction, and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD), and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n = 19 North America, n = 1 Europe; n = 32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42 kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.

BACKGROUND:Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes. METHODS AND FINDINGS:Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures. CONCLUSIONS:Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

Purpose Social determinants of health and poor working conditions contribute to excessive sickness absence and attrition in contact centre advisors. With no recent review conducted, the current scoping review is needed to investigate the volume, effectiveness, acceptability, and feasibility of health-promoting interventions for contact centre advisors. This will inform the adoption and implementation of evidence-based practice, and future research. Methods Searches conducted across four databases (MEDLINE, PsycInfo, CINAHL, Web of Science) and reference checking in February 2023 identified health-promoting interventions for contact centre advisors. Extracted and coded data from eligible interventions were systematically synthesised using the nine intervention functions of the Behaviour Change Wheel and behaviour change technique taxonomy. Results This scoping review identified a low number of high quality and peer-reviewed health-promoting intervention studies for contact centre advisors (28 studies since 2002). Most interventions were conducted in high-income countries with office-based advisors, predominantly using environmental restructuring and training strategies to improve health. Most interventions reported positive effectiveness results for the primary intended outcomes, which were broadly organised into: i) health behaviours (sedentary behaviour, physical activity, smoking); ii) physical health outcomes (musculoskeletal health, visual health, vocal health, sick building syndrome); iii) mental health outcomes (stress, job control, job satisfaction, wellbeing). Few interventions evaluated acceptability and feasibility. Conclusion There is little evidence on the effectiveness, acceptability, and feasibility of health-promoting interventions for contact centre advisors. Evidence is especially needed in low-to-middle income countries, and for remote/hybrid, nightshift, older and disabled advisors.

The extracellular matrix (ECM) is a highly complex structure through which biochemical and mechanical signals are transmitted. In processes of cell migration, the ECM also acts as a scaffold, providing structural support to cells as well as points of potential attachment. Although the ECM is a well-studied structure, its role in many biological processes remains difficult to investigate comprehensively due to its complexity and structural variation within an organism. In tandem with experiments, mathematical models are helpful in refining and testing hypotheses, generating predictions, and exploring conditions outside the scope of experiments. Such models can be combined and calibrated with in vivo and in vitro data to identify critical cell-ECM interactions that drive developmental and homeostatic processes, or the progression of diseases. In this review, we focus on mathematical and computational models of the ECM in processes such as cell migration including cancer metastasis, and in tissue structure and morphogenesis. By highlighting the predictive power of these models, we aim to help bridge the gap between experimental and computational approaches to studying the ECM and to provide guidance on selecting an appropriate model framework to complement corresponding experimental studies.

Abstract Background Women at risk of gestational diabetes mellitus (GDM) need preventative interventions. Objective To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM. Methods Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed. Results Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference − 0.03, 95% CI 0.06, − 0.01; I2 58.69%), inositol (risk difference − 0.19, 95% CI 0.33, − 0.06; I2 92.19%), and vitamin D supplements (risk difference − 0.16, 95% CI 0.25, − 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference − 0.16, 95% CI 0.25, − 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference − 0.17, 95% CI 0.22, − 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant. Conclusions This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.

Abstract Purpose Female athletes train and compete at an elite level during their reproductive years, with an increasing number of athletes navigating an athletic career alongside pregnancy. There is a paucity of research exploring the antenatal experiences of elite athletes. The purpose of this study was to explore the experiences of elite athletes in the United Kingdom as they navigated pregnancy and provide considerations for future research and policy surrounding elite sport participation during pregnancy. Methods Semi-structured online interviews were conducted in elite athletes ≥ 18 years old, who resided in the UK, and who trained and/or competed at the highest level of their sport prior to and/or during pregnancy. A topic guide was used to cover the athletes’ experiences in elite sport, specifically during preconception, pregnancy and the postpartum period. The interviews were recorded, transcribed and analysed using inductive thematic analysis. Demographic data was summarised using IBM SPSS Statistics. Results Eleven UK athletes (mean age 31 ± 3 years) from nine team and individual sports, including sprint, endurance, ball game, power, precision and technical and combat, participated in the study. Four key themes; (1) The identity shift: athlete to mother, (2) From podium to parenthood: preconception and pregnancy planning, (3) Is that my career over?: upon becoming pregnant (4) Navigating the bump: elite training and pregnancy, were developed. The participants spoke about the intrinsic and extrinic challenges, decisions and considerations related to maternal health and elite sport. The experiences described the shifting paradigm of being an athlete and becoming a mother, physical and mental health changes, adapting training, support networks and gaps in knowledge, research and guidance around pregnancy and elite sport. Conclusions This study highlights the challenges elite athletes encounter in balancing an athletic career with motherhood. The findings support policy and research recommendations, advocating for improved access to physical and mental health support, modified training behaviours, tailored nutrition guidance, increased preconception health awareness and maternity funding to enhance inclusivity and better support elite athletes during pregnancy.

Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are households with children. This systematic review and meta-ethnography of qualitative studies focuses on families' perceptions of food insecurity and how it affects children's nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched for studies from European high-income countries between January 2008-July 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies were assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,596 records; we included 19 publications involving 813 participants in total. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified four key themes-food and eating practices, awareness, fragility, and networks of care-comprising five sub-themes. Our meta-ethnography provides a progressive 'storyline' of the children's experiences of food insecurity from both caregivers and children's perspectives. We found that children are aware of their family's limited resources and are often active in trying to help their families cope, and that food insecurity adversely impacts children's physical, psychological, and social experiences. Our analysis highlights gaps in knowledge about how food insecurity impacts children's nutritional health and wellbeing. It suggests that future research should prioritise minoritised ethnic communities, children living in temporary accommodation and caregivers of very young children.

There has been a rise in food insecurity in Europe since the 2008 global financial crisis and households with children are particularly vulnerable. We aimed to explore families' experiences of food insecurity and how these experiences affect children's nutritional health and wellbeing.In this systematic review and meta-ethnography, we searched Medline, Scopus, Web of Science, EMBASE, CINAHL, and ASSIA from Jan 1, 2008, to July 10, 2021, supplemented by grey literature, reference lists, and citation searches. Screening was done in duplicate to ensure consistent application of inclusion criteria and minimise random errors. Following title and abstract screening, full texts were screened against the inclusion criteria (qualitative research focussing on children's nutritional health and wellbeing, with data from 2008 onwards, from high-income European countries). Data extracted included study design, country of origin, caregiver type, gender, age, ethnic group, migration status, accommodation type, measure of food insecurity and other socioeconomic factors. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. Our protocol was registered with PROSPERO (CRD42020214159).We identified 11 589 unique records; 19 were included, involving 813 participants. We identified four key themes: food and eating practices, awareness, fragility, and networks of care. Within the key themes, we identified five subthemes: diet, compromised infant feeding practices, psychological fragility, social fragility, and physical fragility. We found that children with food insecurity were aware of their family's scarce resources, with most active in trying to help their family while also forming their own networks of care. We found that food insecurity adversely affects children's physical, psychological, and social experiences setting them on a trajectory towards sub-optimal health.Children's nutritional health and wellbeing is adversely affected by food insecurity. This meta-ethnography highlights gaps in our knowledge about children's nutritional health relating to a range of sociodemographic factors. There is a need to actively involve children in more research and policy. A strength and limitation of this review is the diverse range of included studies from different European contexts, in which contextual factors could have affected our findings.The Economic and Social Research Council.

The Economic and Social Research Council.

BACKGROUND:Food insecurity is an increasingly important public health concern in high-income countries following the 2008 global financial crash, and recently with the COVID-19 pandemic. Food insecurity has been understood as a highly gendered issue, affecting more women than men. As women have more complex nutritional needs because of their menstrual cycle, pregnancy, and breastfeeding, the nutritional impact of food insecurity is also greater for women than for men. This systematic review aims to explore pregnant women's experiences of food insecurity in high-income countries and to understand how food insecurity affects their health, wellbeing, diet, and nutrition. METHODS:We did a systematic review following PRISMA reporting guidelines. A comprehensive search strategy was developed using search terms such as "food insecurity" and "pregnancy outcomes". We searched seven databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, and CINAHL), grey literature, reference lists, and citations, as well as contacted authors. No language restrictions were used, and only studies primarily containing data collected from Jan 1, 2008, onwards were included. Database searches were completed in April 2022; supplementary searches are ongoing. Inclusion criteria is based on PECOS. Screening, data extraction, and quality assessment were done by two authors independently. This systematic review is registered on PROSPERO, number CRD42022311669. FINDINGS:27 studies met the inclusion criteria, with all studies published between 2015 and 2022. 24 (89%) of 27 studies were done in the USA, two (7%) in Canada, and one (4%) in the UK. Outcomes reported include dietary intake or dietary quality during pregnancy (seven [26%] of 27), gestational weight gain (seven [26%]), mental health (five [19%]), pregnancy outcomes including pregnancy complications, preterm birth, or birthweight (five [19%]), and other health outcomes or combination of nutrition, health, and wellbeing (three [11%]). Evidence synthesis is ongoing and will be complete by August, 2022. INTERPRETATION:This systematic review suggests that food insecurity experienced during pregnancy was associated with negative health and nutrition outcomes. The rigorous searches are strengths of this study. A limitation is the restricted focus on studies done from 2008 onward. More research to guide efficient interventions that address food insecurity among pregnant women is needed. FUNDING:None.