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Pregnant patients in deprived neighborhoods more likely to develop gestational diabetes

Kaiser Permanente study finds risk greater regardless of racial or ethnic background

Pregnant patients living in a deprived neighborhood are more likely to develop gestational diabetes, and the likelihood increases the more economically and socially deprived a neighborhood is, according to new Kaiser Permanente research published in Obstetrics & Gynecology.

The study accounted for known risk factors of gestational diabetes, and still showed a major role for neighborhood deprivation, said lead author Emily Liu, MPH, a programmer analyst with the Kaiser Permanente Division of Research who is pursuing a PhD in epidemiology. “We looked at this relationship in many different ways,” Liu said. “And we found that the results were still robust, and that there was a linear trend, showing the risk increased with higher deprivation.”

Emily Liu, MPH

The researchers used a neighborhood deprivation index that measures socioeconomic status using 8 different metrics, including households in poverty, rates of crowded housing and unemployment, and education levels of residents.

About half of the increased risk may be explained by patients with overweight or obesity, a major risk factor for gestational diabetes. It is a condition that can lead to serious health risks for both mother and baby during the pregnancy and raise the likelihood of long-term health issues after birth.

The relationship between neighborhood deprivation and gestational diabetes risk were not significantly different by race and ethnicity, the study showed.

“Other research has shown race and ethnicity are risk factors for gestational diabetes,” said senior author Monique Hedderson, PhD, a research scientist with the Division of Research. “But it seems that, in addition to racial and ethnic group, neighborhood is also a really important factor. These findings were across the board.”

The analysis included 214,375 pregnancies among Kaiser Permanente Northern California members; 11.3% had gestational diabetes. Prevalence of the condition ranged from 10% in the least deprived areas to 12.7% in the most deprived.

Monique Hedderson, PhD

The researchers looked at factors that might mediate, or explain, the increased risk of gestational diabetes, including pre-pregnancy BMI, weight gain during pregnancy, smoking, and illegal drug use. BMI mediated 45.8% of the association between neighborhood deprivation and gestational diabetes, and the other factors contributed little or none to the results.

The authors said their analysis did not identify what specifically about a deprived neighborhood might increase the disease risk. “There are many factors that might be involved, including access to healthy food, safety and walkability to get exercise, and/or stress,” Hedderson said. “That would be something for future research to explore.”

The results add to the growing evidence about how factors outside of the health care system impact health outcomes, said co-author Mara Greenberg, MD, a maternal fetal medicine specialist and co-director of the Kaiser Permanente Regional Perinatal Service Center. “This adds to our growing understanding of the way social drivers of health can have intergenerational impacts on families, because gestational diabetes impacts not just maternal health but that of the offspring,” Greenberg said. “And that impact extends into childhood and impacts the offspring’s own metabolic health.”

The study was funded by the National Institutes of Health and the Kaiser Permanente Health Policy and Disparities Research Program.

Additional co-authors were Assiamira Ferrara, MD, PhD, and Sneha B. Sridhar, MPH, of the Division of Research.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.


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