Neighbourhood Deprivation and Gestational Diabetes Mellitus in Arizona From the AzPEARS Study

The maternal population residing in rural areas, tribal lands or near the United States-Mexico border are at high risk for adverse pregnancy complications, notably gestational diabetes mellitus (GDM). Few studies have considered the socioeconomic status (SES) attributes of neighbourhoods on maternal health during gestation. Given that the national and global rate of GDM is rising, this analysis moves beyond individual-level factors and investigates the role of neighbourhood deprivation on GDM risk.

To investigate the relationship between neighbourhood deprivation and risk of GDM using Arizona state birth records.

This population-based study of singleton live births (N = 481,113) utilised birth certificates from 2014 to 2020 from the AzPEARS study. Using American Community Survey (5-year data) linked to 2010 US Census tracts, a composite neighbourhood deprivation index (NDI) score (continuous and quartiles) was derived from 8 socioeconomic indicators. Risk ratios (RR) and 95% confidence intervals (95% CI) were used to examine the association between NDI and GDM risk, adjusting for maternal age, maternal education, race/ethnicity, parity, rurality, and birth year.

The state-wide incidence of GDM was 7.8% (n = 37,636) with variation by neighbourhoods (4% to 12%). GDM risk was highest for Native Americans (17.6%), Asian/Pacific Islanders (13.7%) and Hispanic/Latinas (8.3%). Compared to mothers living in areas with the lowest quartile of NDI, mothers living in neighbourhoods with the highest deprivation had an adjusted risk ratio of 1.21 for developing GDM (95% CI 1.18, 1.26).

We observed that neighbourhood deprivation was positively associated with a higher risk of GDM for each increase in quartile. These results suggest that NDI, a proxy for neighbourhood socioeconomic status, may contribute to GDM risk. Identifying high-risk neighbourhoods for place-based interventions targeting the most vulnerable birthing populations may be an effective strategy in the prevention of GDM.