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- W4200278900 abstract "There is mounting evidence that social determinants of health affect perinatal health inequity. Neighborhood deprivation index (NDI) is a composite marker of area-level factors such as poverty, education, and housing. In nonpregnant adults, area-level factors are associated with impaired glucose intolerance (IGT). We aimed to determine the association between NDI and early pregnancy IGT. Retrospective cohort study of patients who delivered singletons ≥20 weeks from 1/1/17-12/31/19 in 2 Philadelphia hospitals. Patients with a valid address and glycosylated hemoglobin (HbA1c) at < 20 weeks’ gestation were included. Those with pregestational diabetes were excluded. The primary outcome was IGT (HbA1c 5.7-6.4%). Addresses were geocoded and census tract NDI (range 0-1, higher means more deprived) was calculated. Multilevel logistic regression and causal mediation models were used to examine associations of NDI with IGT and quantify the extent to which differences in NDI by race might explain racial disparities in IGT. Of 27,644 patients in the study period, 14,892 met inclusion criteria; 44% self-identified as non-Hispanic Black, 57% were Medicaid insured, and 29% were obese. Overall, 1,533 (10%) patients had IGT. In models adjusted for age, BMI, insurance, and parity, per standard deviation increase in NDI, patients had 30% higher odds of IGT (aOR 1.30, 95% CI: 1.21-1.40). Fig. 1 shows maps of NDI and rates of IGT. Black patients were over 4 times more likely to have IGT than white patients (16.0% & 3.5%, respectively, p< 0.0001). Mean (SD) NDI was substantially higher for Black (0.53 [0.12]) than white (0.32 [0.12]) patients (p < 0.0001, Fig 2). Causal mediation analyses revealed that 5% of the Black-white disparity in IGT may be attributable to higher NDI in neighborhoods where Black patients live (p=0.04). Neighborhood deprivation may contribute to disparities in early pregnancy IGT– a surrogate maker of periconceptional metabolic health. Investing in neighborhoods of color may improve perinatal health equity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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- W4200278900 date "2022-01-01" @default.
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- W4200278900 title "Association between maternal neighborhood socioeconomic factors and early pregnancy glucose intolerance" @default.
- W4200278900 doi "https://doi.org/10.1016/j.ajog.2021.11.1238" @default.
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