NEIGHBORHOOD CHARACTERISTICS AND RISK OF GESTATIONAL DIABETES IN NEW YORK CITY

描述（由申请人提供）：妊娠期糖尿病的发生率正在增加，其特征为妊娠期发病的葡萄糖耐受不良。饮食、体力活动和肥胖是妊娠期糖尿病的可改变的危险因素。与此同时，肥胖的增加也引起了人们的关注，这激发了人们对确定肥胖的环境决定因素的兴趣，这些环境决定因素可能会影响个人行为，包括一个人居住的社区的特征。一个可能影响肥胖和妊娠糖尿病风险的社区特征是健康食品的可得性。社区的另一个特点是种族集中。南亚、拉丁美洲、非洲和加勒比妇女患妊娠糖尿病的风险增加，特别是那些在外国出生的妇女。有人认为，移民妇女患病风险增加的部分原因可能是移民后饮食和生活方式的改变。因此，对于移民妇女来说，生活在种族聚居地之外可能会增加她们患妊娠糖尿病的风险，因为她们暴露在饮食和生活方式的更大变化中，同时经历了社会和工具支持的减少。利用纽约市医院出院、出生证明、商业食品和人口普查数据，这项研究将是有史以来第一次研究社区特征与妊娠糖尿病风险之间的关系。以下研究问题将使用多层模型来解决，控制潜在的个人水平（教育、种族、平价、年龄、医疗补助状况）和社区水平（剥夺）混杂因素：1)糟糕的社区食品环境评分（定义为超市、快餐店、水果和蔬菜摊贩以及天然食品商店的数量的组合）是否与妊娠糖尿病的高风险相关？2)该协会的强度是否因母亲的受教育程度和就业状况而有所不同？3)纽约市七个移民群体的邻里食物环境、种族集中度和GDM之间的关系是什么？患有妊娠期糖尿病母亲的婴儿在出生时出现并发症的风险更大，包括巨大儿和分娩时的创伤。在儿童和青少年时期，他们患肥胖症、糖耐量受损和糖尿病的风险也更大。鉴于妊娠期糖尿病发病率的增加，以及风险的种族差异，更多地了解妊娠期糖尿病的背景风险因素对于实现疾病预防控制中心促进健康妊娠和分娩结果以及改善婴幼儿未来疾病的风险因素的目标至关重要。这项研究的独特之处在于，它探讨了女性居住的社区如何影响她们在怀孕期间发生一种重要并发症的风险。关于社区食物环境和种族集中与妊娠糖尿病的关系的信息可以支持健康社区的设计，通过鼓励健康的行为、生活质量和社会联系来促进健康。

DESCRIPTION (provided by applicant): The incidence of gestational diabetes, characterized as glucose intolerance with onset during pregnancy, is increasing. Diet, physical activity, and obesity are modifiable risk factors that have been implicated in gestational diabetes. Concurrently, there has been concern regarding the increase in obesity, motivating interest in identifying environmental determinants of obesity that might impact individual behavior, including features of the neighborhood in which one lives. One neighborhood feature that might impact the risk of obesity and that of gestational diabetes is the availability of healthy foods. Another neighborhood feature is ethnic concentration. South Asian, Latin American, African, and Caribbean women are at an increased risk of gestational diabetes, especially those who are foreign-born. It has been suggested that this increased risk found in immigrant women might in part be due to change in diet and lifestyle upon immigration. Thus, it is likely that for immigrant women, living outside of ethnic enclaves might increase their risk of gestational diabetes by exposing them to greater changes in diet and lifestyle, while experiencing decreased social and instrumental support. Using linked New York City hospital discharge, birth certificate, commercial food, and census data, this study will be the first ever to examine the association between neighborhood characteristics and the risk of gestational diabetes. The following research questions will be addressed using multilevel models controlling for potential individual-level (education, ethnicity, parity, age, Medicaid status) and neighborhood-level (deprivation) confounders: 1) Is a poor neighborhood food environment score, defined as a combination of number of supermarkets, fast food restaurants, fruit and vegetable stands, and natural food stores, associated with higher risk of gestational diabetes?; 2) Does the strength of this association vary according to the mother's education level and employment status?; and 3) What is the association between neighborhood food environment, ethnic concentration and GDM within seven immigrant groups in NYC? Infants of mothers with gestational diabetes are at greater risk of complications at birth including macrosomia and trauma during delivery. They are also at greater risk of obesity, impaired glucose tolerance, and diabetes in childhood and adolescence. Given the increasing incidence of gestational diabetes, along with the ethnic disparity in risk, learning more about contextual risk factors for gestational diabetes is essential for addressing the CDC objectives of promoting healthy pregnancy and birth outcomes and improving risk factors for future disease among infants and toddlers. The proposed study is unique in that it addresses how the neighborhoods in which women live affect their risk of an important complication during pregnancy. Information regarding the associations of neighborhood food environment and ethnic concentration with gestational diabetes can support the design of healthy communities that promote health by encouraging healthy behaviors, quality of life, and social connectedness.