Abstract
            Background: Low birth weight (LBW) is a major public health issue associated with increased  neonatal morbidity and mortality. This study aimed to examine the association between  household food insecurity and LBW in Mashhad, Iran.  
  Study Design: A population-based case-control study.  
  Methods: This study involved 6294 mothers (3247 cases and 3247 controls) who visited  healthcare centers affiliated with Mashhad University of Medical Sciences for term births between  March 2019 and March 2022. Cases included women who delivered neonates weighing<2500  g, while controls delivered babies≥2500 g. Food security was measured using the validated  Household Food Insecurity Access Scale. Logistic regression models examined the associations  between food insecurity and LBW. Geographic information system techniques mapped LBW  distribution in Mashhad.  
  Results: Household food insecurity was significantly associated with higher odds of LBW (adjusted  odds ratio [AOR]=1.25, 95% confidence interval [CI]: 1.03, 1.53). Other risk factors included  younger maternal age (AOR=1.03, 95% CI: 1.01, 1.04), lower maternal education (AOR=0.55,  95% CI: 0.43, 0.71), cesarean delivery (AOR=1.70, 95% CI: 1.40, 2.06), and exposure to  secondhand smoke (AOR=1.68, 95% CI: 1.02, 2.75). Gestational diabetes demonstrated a  protective effect (AOR=0.37, 95% CI: 0.15, 0.91). Geographic mapping revealed that regions  with higher food insecurity had elevated LBW prevalence.  
  Conclusion: These findings underscore the importance of addressing food insecurity among  pregnant women to reduce the risk of LBW and improve newborn outcomes.