Association of community-level food insecurity and glycemic control among pregnant individuals with pregestational diabetes.
Association of community-level food insecurity and glycemic control among pregnant individuals with pregestational diabetes.
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DOI：
10.1016/j.pcd.2022.11.002
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发表时间：
2023-02
影响因子：
2.9
通讯作者：
Walker, D. M.
中科院分区：
文献类型：
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作者：
Kartik K. Venkatesh;Joseph, J. J.;Clark, A.;Gabbe, S. G.;Landon, M. B.;Thung, S. F.;Yee, L. M.;Lynch, C. D.;Grobman, W. A.;Walker, D. M.
评估居住在食品不安全社区的患有孕前糖尿病的孕妇与不居住在食品不安全社区的孕妇相比，其血糖控制是否较差。对参加多学科产前和糖尿病护理计划的患有妊娠前糖尿病的孕妇进行回顾性分析。根据食品获取研究地图集，暴露的是社区一级的粮食不安全。结果是妊娠早期和晚期的血红蛋白 A1c (A1c) < 6.0 %，A1c 的绝对下降≥ 2.0 %，整个妊娠期间 A1c 的平均变化。在 418 名接受评估的患有孕前糖尿病的孕妇中，与生活在没有粮食不安全的社区的人相比，生活在粮食不安全的社区的人在妊娠早期 A1c < 6.0% 的可能性较小 [16% vs. 30%；调整后风险比（aRR）：0.55； 95% CI：0.33–0.92]。生活在粮食不安全社区的个人更有可能实现 A1c 降低 ≥ 2.0 % [35 % vs. 21 %；相对比：1.55； 95 % CI：1.06–2.28]并且整个怀孕期间 A1c 平均下降幅度更大[平均值：1.46 vs. 1.00；调整后贝塔值：0.47； 95% CI：0.06–0.87)]。生活在粮食不安全社区的患有孕前糖尿病的孕妇在怀孕时血糖得到控制的可能性较小，但与生活在没有粮食不安全的社区的孕妇相比，糖化血红蛋白 (A1c) 降低并达到相似的糖化血红蛋白 (A1c) 状态的可能性更大。解决粮食不安全问题的干预措施是否能改善血糖控制和随之而来的围产期结局仍有待研究。
To evaluate whether pregnant individuals with pregestational diabetes who live in a food-insecure community have worse glycemic control compared to those who do not live in a food-insecure community. A retrospective analysis of pregnant individuals with pregestational diabetes enrolled in a multidisciplinary prenatal and diabetes care program. The exposure was community-level food insecurity per the Food Access Research Atlas. The outcomes were hemoglobin A1c (A1c) < 6.0 % in early and late pregnancy, and an absolute decrease in A1c ≥ 2.0 % and mean change in A1c across pregnancy. Among 418 assessed pregnant individuals with pregestational diabetes, those living in a food-insecure community were less likely to have an A1c < 6.0 % in early pregnancy compared to those living in a community without food insecurity [16 % vs. 30 %; adjusted risk ratio (aRR): 0.55; 95 % CI: 0.33–0.92]. Individuals living in a food-insecure community were more likely to achieve a decrease in A1c ≥ 2.0 % [35 % vs. 21 %; aRR: 1.55; 95 % CI: 1.06–2.28] and a larger mean decrease in A1c across pregnancy [mean: 1.46 vs. 1.00; adjusted beta: 0.47; 95 % CI: 0.06–0.87)]. Pregnant individuals with pregestational diabetes who lived in a food-insecure community were less likely to enter pregnancy with glycemic control, but were more likely to have a reduction in A1c and achieve similar A1c status compared to those who lived in a community without food insecurity. Whether interventions that address food insecurity improve glycemic control and consequent perinatal outcomes remains to be studied.