TUCSON, Ariz. — New research from the University of Arizona Mel and Enid Zuckerman College of Public Health showed that living in resource-poor neighborhoods may raise the risk of women developing diabetes during pregnancy, a condition with potential long-term effects on the health of both mother and child.
Researchers found that mothers living in more deprived neighborhoods in Arizona were 20% more likely to have gestational diabetes mellitus, or GDM, compared with those living in neighborhoods with adequate resources. They reported their findings in Paediatric and Perinatal Epidemiology .
The results add to growing evidence of the potential influences of neighborhood conditions on the health of pregnant women, especially for diabetes. They also point to a need to identify those communities that could benefit from preventative measures.
"Where you live can influence your health. It can impact stress, access to quality food, the ability to interact with the outdoors and exercise – all factors that can affect health," said Melissa Furlong, PhD, an assistant professor of environmental health sciences who was the senior author on the study. "We know there are racial disparities in GDM, and we wanted to go beyond that and more fully gauge the importance of social determinants of health at a neighborhood level."
The research team, including first author and former U of A graduate student Kimberly Parra, PhD, used birth certificate and maternal health information from the Arizona Prenatal Environment and Reproductive Outcomes Study. They examined more than 480,000 births in 15 Arizona counties between 2014 and 2020.
They combined that information with the Neighborhood Deprivation Index, or NDI, a mashup of neighborhood-related factors such as housing quality, violence, education, access to healthy food and poverty that reflects socioeconomic status in a neighborhood.
Then, they compared where women lived when they gave birth with values calculated from the NDI.
"We compared people who live in highly deprived neighborhoods to those who live in less deprived neighborhoods and looked at the risk of GDM by neighborhood score," Furlong explained. "We found women living in neighborhoods with higher deprivation scores were more likely to have GDM. The results suggest the neighborhood you live in has some influence on your risk for GDM."
The study showed that overall, approximately 7.8% of the women had GDM, which was similar to the incidence in the general population; however, neighborhood location and make up mattered. For example, the GDM incidence was as high as 12% in communities with a high proportion of patients identifying as Native American or American Indian. Those living in poorer neighborhoods had smaller babies and were younger, less educated, more overweight and more likely to have public insurance.
The study found that Native Americans had a high incidence of GDM – almost 18% – which is more than double the overall incidence in the general population.
Prior research has linked neighborhood conditions to a lower control of diabetes, but few studies have examined the impact of socioeconomic factors on the development of diabetes in pregnant women living in poor neighborhoods.
"From a policy perspective, there could be more emphasis on eliminating food deserts, for example, and promoting programs that increase access to higher quality housing, healthy food and prenatal care," Furlong said.
The results also highlight the need to better understand the factors contributing to the higher incidence of GDM among Native Americans and find ways to address the disparity.
Furlong noted there is much more to learn about the potential role neighborhoods play in influencing maternal health.
"This is only a characterization of people who live in these areas who have a higher risk for diabetes," she said. "We'd like to know many more details about the neighborhoods themselves and how they can impact the health of people who live there."
Additional co-authors from the Zuckerman College of Public Health include Leslie Farland, ScD, an associate professor of epidemiology, and Robin Harris, PhD, a professor emeritus of epidemiology. Parra is now a postdoctoral research fellow at Harvard University.
This work was supported in part by the National Institute of Environmental Health Sciences, a division of the National Institutes of Health, under awards nos. R00ES028743 and 5T32ES007069.
