The federal government’s new Dietary Guidelines for Americans, released in January 2026, deliver a simple message: “Eat real food.” While seemingly straightforward, this advice presents a significant challenge for pregnant women, particularly those in rural communities who face barriers to accessing healthy, whole foods.
Researchers Bethany Barone Gibbs, professor of Epidemiology and Biostatistics at West Virginia University, and Alex Crisp, a postdoctoral research scholar at the University of Iowa, are investigating these challenges through the Pregnancy 24/7 Cohort Study. This five-year observational study examines how daily behaviors during pregnancy impact maternal and fetal health, including the risk of complications.
Currently, most pregnant women in the United States aren’t meeting recommended dietary guidelines. This disparity is even more pronounced for women living in rural areas. A recent study by Gibbs and Crisp, involving 500 pregnant participants recruited from clinics in Pennsylvania, West Virginia, and Iowa, revealed that rural pregnant women consume approximately half a teaspoon more of added sugars daily from sugar-sweetened beverages compared to their urban counterparts. They also consume less fiber and fewer vegetables.
These less healthy dietary habits may contribute to the increased risk of pregnancy complications observed in rural populations, such as preterm birth, gestational diabetes, and hypertensive disorders. Inadequate nutrition during pregnancy can have long-term consequences, potentially leading to obesity and diabetes in both mothers and children, perpetuating cycles of poor health across generations.
Poverty, Not Just Location, Drives Dietary Differences
The study also explored the influence of socioeconomic status on dietary patterns. Researchers found that while rural women generally had poorer diets than urban women, socioeconomic status played a crucial role. Among participants in Pittsburgh, Pennsylvania, those with lower incomes consumed 1.29 to 1.49 more teaspoons of added sugars per day, and 1.5 to 1.6 grams less fiber per day compared to their higher-income peers. They also had lower calcium intake.
This suggests that income and education level are stronger predictors of diet quality than geography alone. While Pittsburgh participants and urban participants at other study sites generally fared better than their rural counterparts, these improvements were largely linked to socioeconomic factors.
Approximately 20% of the U.S. Population lives in rural areas. Pregnant women in these regions often face significant obstacles in accessing nutritious foods. They may need to travel long distances to find stores offering fresh produce and whole grains. Closer to home, convenience stores, gas stations, and dollar stores typically stock processed, calorie-dense foods with limited nutritional value. Even when healthier options are available, they often come at a higher cost.
These dietary patterns are particularly concerning given the increased nutritional needs of pregnant women. They require adequate intake of essential nutrients like calcium, iron, folate, and choline. Calcium, found in dairy, fortified plant milks, and leafy greens, supports bone development. Iron and folate, present in beans, lentils, and dark green vegetables, are vital for fetal growth. Choline, found in eggs, beans, and nuts, supports brain and spinal cord development.
Making “Eat Real Food” Accessible
The 2025-2030 Dietary Guidelines emphasize consuming whole, minimally processed foods and limiting sugar-sweetened beverages and highly processed items. However, as the study highlights, following this advice can be more challenging for some women during pregnancy.
To address these challenges, Gibbs and Crisp suggest that pregnant women in rural and low-income communities could benefit from programs that increase access to affordable, nutritious foods. This could include subsidies for fresh produce or expanded access to supplemental nutrition assistance programs (SNAP).
The USDA’s Shop Simple with MyPlate tool provides practical strategies for healthy eating on a budget. These include meal planning, avoiding impulse purchases, and incorporating a mix of fresh, frozen, and canned foods. Frozen and canned fruits and vegetables, without added salt or sugar, offer comparable nutritional value, longer shelf life, and often lower costs than fresh produce. Choosing water over sugary drinks, opting for whole grains like oatmeal and brown rice, and utilizing affordable protein sources such as beans, lentils, and eggs can also improve diet quality and make a meaningful difference for both mother and baby.
