Objective: To determine whether women living in highly deprived neighborhoods, defined by Area Deprivation Index (ADI), have worse glycemic control than those in less deprived areas.
Methods: We performed a retrospective cohort study of low-income, previously uninsured pregnant women with T2DM from 2007-2017. We compared women living in high (≥ top quartile) or middle (middle quartiles) ADI neighborhoods to those living in low (≤bottom quartile) ADI neighborhoods. Demographic characteristics were compared and trends in mean A1c throughout pregnancy were tested with repeated measures analysis.
Results: Of 367 women meeting study criteria (ADI range 1-10; IQR 7-10), 81 lived in low, 181 in middle, and 105 in high ADI neighborhoods. Demographics were similar between groups, except the high ADI group had more Black women and more severe diabetes by White Class. All groups achieved significant improvement in HgbA1c; however, the high ADI group was unable to achieve the same level of glycemic control by the third trimester after controlling for race and disease severity. There were no differences in pregnancy outcomes.
Conclusion: Intensive prenatal care was insufficient to overcome neighborhood deprivation with regard to glycemic control; thus, additional neighborhood level interventions are likely needed to overcome this inequality.
L. Zahedi-Spung: None. B.E. Polnaszek: None. H.E. Duckham: None. C.J. Herrick: None. E.B. Carter: None.
American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); Robert Wood Johnson Foundation (74250); Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD095075)