The latest Dietary Guidelines for Americans, published by the federal government in January 2026, deliver a clear message: “Eat real food.” However, for pregnant women living in rural parts of America, this seemingly simple advice confronts significant barriers.
As a public health professor and a postdoctoral researcher engaged in the Pregnancy 24/7 Cohort Study at West Virginia University and the University of Iowa, we have been examining how daily behavioral patterns during pregnancy affect both maternal and fetal health outcomes.
It is evident that most pregnant women in the United States do not meet recommended dietary guidelines, a reality further pronounced among those in rural communities. In our recent study, we surveyed 500 pregnant women from university-affiliated clinics in Pennsylvania, West Virginia, and Iowa, asking them about their dietary habits during each trimester.
Approximately 20% of the participants resided in rural areas, as determined through federal classification. Our findings indicated that pregnant women in these regions consumed more added sugars from sugar-sweetened beverages—about half a teaspoon more per day—compared to their urban counterparts. Additionally, rural women consumed less fiber and fewer vegetables overall.
Research indicates that such poor dietary habits might contribute to a higher incidence of complications among rural pregnant women, including issues like preterm birth, gestational diabetes, and hypertensive disorders.
Nutritional deficiencies during pregnancy can lead not only to these complications but may also result in long-term issues such as obesity and diabetes. If these nutritional gaps are not addressed, they could perpetuate poor health across generations.
Poverty, Not Just Location, Influences Dietary Choices
Our study also explored the role of socioeconomic status on dietary choices for pregnant women in both rural and urban settings. Most rural data originated from participants in West Virginia and Iowa.
In Pittsburgh, our data included 124 participants, of whom nearly all were classified as “urban.” Compared to their rural counterparts, urban women significantly reduced their intake of added sugars from sugar-sweetened beverages during the first two trimesters and generally maintained higher fiber consumption throughout their pregnancies.
However, socioeconomic status within the Pittsburgh cohort was found to be a more significant predictor of diet quality. Participants with lower socioeconomic status—many from Pittsburgh—consumed 1.29 to 1.49 teaspoons more of added sugars and 1.5 to 1.6 grams less fiber per day than those with higher socioeconomic status. Additionally, lower-income women reported daily calcium intakes that were 31 to 58 milligrams lower.
While urban participants in Pittsburgh and other sites generally performed better in certain dietary measures, it became clear that income and educational levels were more critical determinants of diet quality than geographical location alone.
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Approximately 20% of the U.S. population resides in rural areas . Pregnant women in these regions often face long distances to procure fresh produce and whole grains. The nearest food sources tend to be convenience stores, gas stations, or dollar stores, which offer primarily processed foods that are calorie-dense yet nutritionally poor. Even when healthier options are available, they are often more expensive.
These unhealthy dietary trends are particularly alarming as pregnant women have greater nutritional needs than non-pregnant women. Low-income and rural pregnant women frequently miss essential nutrients such as calcium, iron, folate, and choline. Calcium, vital for bone development, is found in dairy products, fortified plant milks, and leafy greens. Iron and folate, which support the growth of the baby, can be sourced from beans, lentils, and dark green vegetables. Choline is essential for brain and spinal cord development and is available in eggs, beans, and nuts.
Making ‘Eat Real Food’ Attainable
The new dietary guidelines emphasize key principles for all adults, including the importance of consuming whole and minimally processed foods, while avoiding sugar-laden beverages and highly processed items.
While the directive to “eat real food” appears straightforward based on extensive research, our findings underscore the challenges some women face in adhering to this guidance during pregnancy. Subsidies for fresh produce and increased nutrition assistance could be particularly beneficial for pregnant women in rural and low-income areas.
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The USDA’s Shop Simple with MyPlate tool provides practical strategies for maintaining a healthy diet while on a budget. Planning weekly meals, minimizing impulse buys, and incorporating a mix of fresh, frozen, and canned goods are effective methods for achieving this.
Frozen and canned fruits and vegetables (without added salt or sugar) retain their nutritional value, have longer shelf lives, and are often more affordable than fresh options, helping to reduce waste. Opting for water instead of sugary drinks, purchasing whole grains like oatmeal and brown rice, and choosing budget-friendly protein sources such as beans, lentils, and eggs can enhance dietary quality and stretch financial resources. This approach can significantly benefit both mothers and their babies.
