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Study Team

Leela Thomas, Delaware State University (PI); James Lenhard, Christiana Care (Co-PI); Mitch Fawcett, Christiana Care; Claudine Jurkovitz, iReach

What we wanted to learn and why it matters

Gestational diabetes mellitus (GDM) occurs in the second or third trimester of pregnancy, and if uncontrolled can lead to maternal and neonatal complications. Studies on disparities in GDM outcomes have focused largely on individual characteristics. A growing body of epidemiological evidence asserts that community characteristics, such as racial residential segregation and income inequality also contribute to health disparities. The association of these variables have rarely been examined in GDM. The objective of our study was to assess whether neighborhood characteristics were associated with patients’ management of GDM and complications of GDM.

What we did and learned

We built a data set that included patient clinical data from the medical records and census data. Patient data included 2,189 women with gestational diabetes who had singleton live births between January 1, 2014 – December 31, 2018. Over half (51%) were white, 20% were African American and 29% were other races; almost all (92%) lived in New Castle county. We found substantial racial segregation, income inequality, and neighborhood deprivation by census tract. We found significant positive associations between adverse birth outcomes such as shoulder dystocia and neighborhood characteristics including the percentage of households living below the poverty level in the neighborhood, percentage of African Americans in the neighborhood, percentage of female headed households in the neighborhood, and percentage of overall unemployment rate in the neighborhood.


Thomas, L., Fawcett, M., Jurkovitz, C., Lenhard, J. M., “Association between Residential Environment and Gestational Diabetes Complications,” Academy Health 2020 Annual Research Meeting, July 28, 2020 – August 6, 2020, interactive poster presentation. In – Person meeting in Boston canceled due to COVID-19.

Thomas, L., Fawcett, M., Jurkovitz, C., Lenhard, J. M., “Residential Inequality and Birth Outcomes of Gestational Diabetes,” American Diabetes Association’s Virtual 80th Scientific Sessions, June 12-16, 2020. In-Person meeting in Chicago, Illinois, canceled due to COVID-19.

To read more about this study