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Food insecurity rates rose with potential negative ramifications for infant feeding methods. The relationship between food insecurity and infant feeding practices since the onset of the pandemic is not yet fully understood. We examined these relationships in a cohort of infants born during the onset and aftermath of the COVID-19 pandemic in New York City.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis of infants enrolled from birth into the COVID-19 Mother-Baby Outcomes (COMBO) study and born March 2020 to May 2024. We measured food insecurity risk in the prior 30 days with a 2-item survey adapted from Hunger Vital Sign\u2122, infant feeding confidence at hospital discharge, and current infant feeding practices. Associations between food insecurity and infant feeding outcomes were examined using multivariable regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In our sample, 40% of women had been exposed to prenatal SARS-CoV-2 infection and approximately 24% of mothers were experiencing food insecurity. Food insecurity risk was significantly associated with prenatal SARS-CoV-2 infection, Spanish as one\u2019s preferred language, and self-identifying as Latina. On unadjusted models, food insecurity was associated with formula feeding, with 44% of mothers experiencing food insecurity opting to formula feed vs. 28% of food secure mothers (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but this relationship was no longer significant after adjusting for covariates (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06). On adjusted models stratified by early (March 2020-December 2021) and later waves of the pandemic (January 2022-May 2024), food insecurity was significantly associated with increased formula feeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Food insecurity was associated with infant feeding practice on the unadjusted model of the entire sample but not after adjusting for confounders. Food insecurity risk was significantly associated with lower odds of exclusive breastfeeding in each distinct wave of the pandemic on stratified analyses. These findings suggest potential influence of unmeasured, fluctuating external factors across the 2020\u20132024 time period, such as health and social services policy changes, social support variations, and the 2022 formula shortage. Our findings suggest a continued need for targeted screening of postpartum mothers for food insecurity and targeted services that support exclusive breastfeeding, especially among food-insecure mothers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13006-026-00838-5","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T16:06:22Z","timestamp":1775923582000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of food insecurity risk on infant feeding confidence and practices during the COVID-19 pandemic and its waves"],"prefix":"10.1186","volume":"21","author":[{"given":"Maha","family":"Hussain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Hyun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Arduin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret H.","family":"Kyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda","family":"Abreu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Scripps","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrita","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Glassman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa S.","family":"Stockwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Walzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani","family":"Dumitriu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina R.","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"838_CR1","unstructured":"Centers for Disease Control and Prevention. 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