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Research: Examining the association between neighborhood environment and complications of gestational diabetes mellitus

A group of Delaware researchers recently published a paper titled “Neighborhood Environment and Poor Maternal Glycemic Control–Associated Complications of Gestational Diabetes Mellitus” in the American Journal of Preventive Medicine Focus.

The retrospective study was conducted with pilot funding through the DE CTR ACCEL program and utilized data from ChristianaCare to investigate the relationship between neighborhood environmental conditions and gestational diabetes mellitus.

Dr. Leela Thomas, a professor at Delaware State University and a researcher on the study, shared some insight regarding the project, its goal, and the impact of ACCEL pilot funding.

What is the significance of this paper and its research?

Trends suggest that the occurrence of adverse pregnancy outcomes associated with gestational diabetes is increasing in the United States. The incidence rate is higher among individuals from racial minority groups than among White individuals, leading to widening racial disparities in the number of pregnancies with complications.  Randomized controlled trials on the effect of intervention on pregnancy outcomes have focused largely on clinical interventions—such as diet, exercise, and pharmacological therapy—to prevent complications. The results of the trials have been promising; however, the success of these randomized trials has not been replicated in the lives of many individuals who live outside the controlled setting. Our study focused on the association between the environment in which the individuals live and the likelihood of experiencing adverse pregnancy outcomes due to poor maternal glycemic control.

Why did you want to conduct this research?

While advances are being made in medicine to manage gestational diabetes and prevent complications, national data suggest that the number of pregnant individuals with gestational diabetes developing complications is increasing, and the increase is greater among individuals from racial minority groups than among White individuals. This suggested that we needed to study factors outside of clinical settings. Hence, we examined structures in the individual’s residential environment that could be associated with complications resulting from poor maternal glycemic control.   

What new information or insight do you believe this paper adds to the study of gestational diabetes mellitus or the study of relationships between health and environmental conditions at large?

We found that once neighborhood structural factors, age, and obesity were equal, mother’s race had no significant association with complications.

The odds of adverse pregnancy outcomes were 35% higher for individuals who resided in neighborhoods that had a higher percentage of households living below the poverty level than for those from neighborhoods that had a smaller percentage of households living below the poverty level.

As poverty contributes to stress—which can elevate blood glucose levels and make it difficult for individuals to adhere to medically prescribed clinical regimen, thus leading to complications—we recommend that during clinical visits, low income individuals be informed of and assisted in participating in programs such as Section 8 Housing Choice Voucher, federal home energy assistance program, and the Individual Development Account (IDA) which is a state program designed to assist low-income individuals build assets, all of which could help to alleviate the stress of poverty.

What was one of the major obstacles that you had to overcome while conducting the research for this paper? What aspect of the ACCEL program was most helpful to you for this research?

Our two attempts at obtaining NIH funds for such a study were unsuccessful, and one of the reviewers recommended that we demonstrate through a pilot study that we could indeed do the project. However, we lacked the funds to conduct a pilot study. In addition, despite repeated attempts, we could not get access to hospital data on women and infants. The ACCEL Pilot award provided the funds to do a pilot study and, due to the partnership that exists between the universities and hospitals in the ACCEL-CTR Program, we were able to obtain access to ChristianaCare data.  Also, BERD provided methodological and statistical support for the study which enhanced its quality.  Without the support of ACCEL this study would not have been possible.

The paper’s list of authors include:

  • Leela Thomas PhD, Department of Social Work, Wesley College of Health and Behavioral Sciences, Delaware State University
  • Claudine Jurkovitz MD, MPH, Institute for Research in Equity and Community Health (iREACH), ChristianaCare
  • Zugui Zhang PhD, FAHA, Institute for Research in Equity and Community Health (iREACH), ChristianaCare
  • Mitchell R. Fawcett MBA, Institute for Research in Equity and Community Health (iREACH), ChristianaCare
  • M. James Lenhard MD, FACP, FACE, Endocrinology and Metabolism, Metabolic Health, ChristianaCare and Sidney Kimmel Medical College, Thomas Jefferson University