Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus.
Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus.
复制标题
怀孕早期的邻居剥夺与妊娠糖尿病之间的关联。
DOI：
10.1097/aog.0000000000005521
复制
发表时间：
2024
影响因子：
7.2
通讯作者：
Hedderson,MoniqueM
中科院分区：
文献类型：
--
作者：
Liu,EmilyF;Ferrara,Assiamira;Sridhar,SnehaB;Greenberg,MaraB;Hedderson,MoniqueM
目的：评估是否有一个贫穷的邻居怀孕与妊娠期糖尿病（GDM）的风险增加相比，有一个怀孕在最贫穷的neighborhoods.METHODS：这是一个回顾性观察队列研究的怀孕的个人在凯撒永久北方加州从2011年至2018年的居住史从孕前到24周的妊娠和临床数据从孕前到分娩。主要结局是GDM的诊断。邻里贫困的特点是一个指数聚合多个指标的人口普查区一级的社会人口信息。中介分析采用反比比加权估计中介效应的孕前体重指数（BMI），妊娠期体重增加，吸烟，非法药物使用前GDMdiagnosis.RESULTS：总体而言，214,375怀孕的人，11.3%的诊断为GDM。糖尿病患病率随着邻里贫困程度的增加而增加，从邻里贫困指数最低的五分之一的10.0%增加到最高的五分之一的12.7%。与生活在贫困程度最低的社区的孕妇相比（五分位数1），五分位数2-5中的孕妇患GDM的风险升高（相对风险[95% CI]），根据母亲年龄、产次、保险类型和居住史进行调整后（五分之2，1.17 [1.10-1.23];五分之3，1.38 [1.30-1.46];五分之4，1.54 [1.45-1.63];五分之5，1.71 [1.62-1.82]）。GDM的相对危险度与邻里剥夺的五分位数增加呈剂量反应关系（P <0.05）。001）。孕前BMI介导了45.8%（95% CI，40.9-50.7%）的相关性。其他潜在的介质被发现调解一个小的，如果不能忽略不计的比例，这种协会（2.4-3.6%）。结论：邻里剥夺与GDM，和相当大的比例，这种关系是由孕前BMI介导的。
OBJECTIVE:To evaluate whether having a pregnancy in a deprived neighborhood was associated with an increased risk of gestational diabetes mellitus (GDM) compared with having a pregnancy in the least-deprived neighborhoods.METHODS:This was a retrospective observational cohort study of pregnant individuals within Kaiser Permanente Northern California from 2011 to 2018 with residential history from prepregnancy through 24 weeks of gestation and clinical data from prepregnancy through delivery. The primary outcome was a diagnosis of GDM. Neighborhood deprivation was characterized with an index aggregating multiple indicators of Census tract–level sociodemographic information. Mediation analysis using inverse odds ratio weighting estimated the mediation effects of prepregnancy body mass index (BMI), gestational weight gain, smoking tobacco, and illegal drug use before GDM diagnosis.RESULTS:Overall, 214,375 pregnant individuals were included, and 11.3% had a diagnosis of GDM. Gestational diabetes prevalence increased with neighborhood deprivation from 10.0% in the lowest Neighborhood Deprivation Index quintile to 12.7% in the highest quintile. Compared with pregnant individuals in the least deprived neighborhoods (quintile 1), pregnant individuals in quintiles 2–5 had elevated risk of GDM (relative risk [95% CI]) when adjusted for maternal age, parity, insurance type, and residential history (quintile 2, 1.17 [1.10–1.23]; quintile 3, 1.38 [1.30–1.46]; quintile 4, 1.54 [1.45–1.63]; quintile 5, 1.71 [1.62–1.82]). There was a dose-response relationship between relative risk of GDM and increasing quintile of neighborhood deprivation (P for trend<. 001). Prepregnancy BMI mediated 45.8%(95% CI, 40.9–50.7%) of the association. Other potential mediators were found to mediate a small if not negligible proportion of this association (2.4–3.6%).CONCLUSION:Neighborhood deprivation was associated with GDM, and a considerable proportion of this relationship was mediated by prepregnancy BMI.