Why Pregnant Women in Rural America Are Missing Critical Nutrients—And What Needs to Change

Rural and low-income pregnant women in the United States are consuming significantly fewer nutrients than their urban, higher-income counterparts, according to a major five-year study. Researchers found that pregnant women living in rural areas consumed about half a teaspoon more added sugars from sugar-sweetened beverages per day than urban women, while also eating less fiber and fewer vegetables. These dietary gaps aren't about personal choice—they're driven by limited access to fresh, whole foods and financial barriers that make healthy eating nearly impossible for many expectant mothers.

What's Really Driving the Nutrition Gap in Rural Pregnancy?

The Pregnancy 24/7 Cohort Study, conducted by researchers at West Virginia University and the University of Iowa, tracked 500 pregnant women across Pennsylvania, West Virginia, and Iowa to understand how their daily habits affected maternal and fetal health. About one in five participants lived in rural areas. The findings revealed a troubling pattern: socioeconomic status—not just geography—emerged as the strongest predictor of diet quality during pregnancy.

Women with lower incomes consumed significantly more added sugars and less of the nutrients their growing babies need. Compared to higher-income women, low-income participants consumed 1.29 to 1.49 more teaspoons per day of added sugars from sugar-sweetened beverages and 1.5 to 1.6 grams less fiber per day. They also consumed 31 to 58 milligrams less calcium per day—a critical nutrient for fetal bone development.

Which Nutrients Are Pregnant Women Missing Most?

The research identified four key nutrients that low-income and rural pregnant women are often not getting enough of:

• Calcium: Supports bone development in the growing baby and is found in dairy products, fortified plant-based milks, and leafy greens—foods that are often more expensive or less available in rural areas.
• Iron: Essential for supporting the baby's growth and preventing anemia in the mother; found in beans, lentils, and dark green vegetables.
• Folate: Helps prevent birth defects and supports fetal development; also found in beans, lentils, and dark leafy greens.
• Choline: Assists with brain and spinal cord development and can be found in eggs, beans, and nuts.

The problem is access. About 20% of the U.S. population lives in rural areas where pregnant women often must travel long distances to reach fresh produce and whole grains. The food outlets closer to home—convenience stores, gas stations, and dollar stores—primarily stock processed, calorie-dense foods with lower nutritional value. Even when healthier options are available, they cost significantly more than processed alternatives.

How Do Poor Pregnancy Diets Affect Mother and Baby?

The consequences of these nutrition gaps extend far beyond pregnancy. Research suggests that less healthy dietary habits during pregnancy are linked to serious complications, including preterm birth, gestational diabetes, and hypertensive disorders—conditions that can have lifelong effects on both mother and child.

Diets lacking adequate nutrition during pregnancy can also lead to obesity and diabetes in both mother and baby, perpetuating cycles of poor health across generations. This is why the federal government's new Dietary Guidelines for Americans, released in January 2026, emphasize eating whole and minimally processed foods while avoiding sugar-sweetened beverages and highly processed foods. But as researchers note, telling Americans to "eat real food" is straightforward advice—until you're a pregnant woman without reliable access to it.

What Solutions Could Help Rural and Low-Income Pregnant Women?

The research team suggests that pregnant women in rural and low-income communities could benefit from targeted interventions, including subsidies for fresh produce and expanded supplemental nutrition assistance programs. These policy-level changes could help bridge the gap between federal dietary recommendations and the reality of what's actually available and affordable for expectant mothers.

Meanwhile, some healthcare systems are taking a different approach to improving pregnancy outcomes. The University of Mississippi Medical Center is launching a new CenteringPregnancy clinic beginning March 10, 2026, at the Myrlie Evers-Williams Institute for the Elimination of Health Disparities. This community-centered model brings eight to ten pregnant women with similar due dates together for prenatal care, combining individual health assessments with group education and peer support on topics like labor, delivery, breastfeeding, and infant care.

"CenteringPregnancy is one of the few interventions shown to reduce the risk of preterm birth, by almost 40% in many studies," said Dr. Thomas Dobbs, director of the institute and dean of the John D. Bower School of Population Health. Research also suggests that this model can significantly reduce racial disparities in birth outcomes.

The reality is that pregnancy nutrition isn't just a personal responsibility—it's a public health issue shaped by geography, income, and access. Until rural and low-income pregnant women have equal access to affordable, nutritious foods, the dietary gaps identified in this research will continue to put vulnerable mothers and babies at risk.