A more comprehensive understanding of gestational diabetes mellitus (GDM) risk factors is needed given its increasing incidence and association with adverse maternal and fetal outcomes. Physical and social environments may play an important role in GDM because of their relationship to known risk factors such as physical activity, diet, and other lifestyle behaviors. We used logistic regression to examine the relationship between neighborhood deprivation index (NDI) , a composite score employing US Census indicators of education, income and poverty, employment, housing, and occupation, and GDM in a large and racially diverse cohort of livebirths between 20 and 2018 (n = 167,287) in Kaiser Permanente Northern California. GDM was defined by the Carpenter and Coustan criteria. Overall, 12,238 (7.4%) of pregnancies had GDM. When stratified by quartiles of NDI, GDM prevalence increased with neighborhood deprivation -- from 2,674 (6.5%) in the least deprived quartile to 3,432 (8.3%) in the most deprived quartile. Adjusted model results showed increased GDM risk as higher neighborhood deprivation quartiles were compared to the least deprived quartile (Table 1) . The test for linear trend was statistically significant (p≤0.05) .

In conclusion, additional emphasis should be placed on social determinants of health prior and during pregnancy when evaluating GDM risk and working towards health equity in maternal and fetal outcomes.


E.F.Liu: None. S.B.Sridhar: None. A.Ferrara: n/a. M.Greenberg: None. M.M.Hedderson: None.


Kaiser Permanente Health Policy and Disparities Research Program grant

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