Policy levers to reduce racial-ethnic inequities in diabetes after gestational diabetes

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Project Summary Gestational with life data population-based Linkage disparities non-Latina emerge identify diversity. women physiologically. potential concurrent the modeling the to Next, conducting pregnancy, we outcomes alter on the prevention Our reduce diabetes (GDM) is a common complication of pregnancy with substantial racial-ethnic disparities, women of color facing the greatest disadvantage. These GDM disparities have profound implications for course disparities in type 2 diabetes (T2DM) and cardiovascular disease. Recently we conducted a novel linkage between New York City birth certificate and HbA1c registry databases to construct a multiethnic cohort to follow women after delivery from 2009-2019, the A1c in Pregnancy and Postpartum for Equity (APPLE) NYC Cohort. When following women with GDM, we found stark racial-ethnic in progression to T2DM, with Black, Latina, and South Asian women having 2 to 4.5 times the risk of White women. Despite these important findings, very little is known about what causes disparities to in the years after a GDM pregnancy. Current research focuses on individual risk; however, it does not neighborhood contextual risk factors to inform targets for policy intervention nd lacks racial-ethnic Structural inequities and neighborhood context may be especially potent in the postpartum eriod, as of color often face social and economic challenges while their bodies recover and continue to evolve Identifying policy levers to intervene "upstream” during the critical postpartum period has the to dismantle structural inequities that drive individual level T2DM risk f actors. Therefore, we propose a mixed-methods study, leveraging our retrospective cohort of 21,695 multiethnic women with GDM, APPLE NYC Cohort, qualitative interviews with postpartum women, and an innovative systems science approach. Our overall goal is to identify policy levers to prevent progression t o T2DM after GDM in postpartum period and reduce racial-ethnic disparities. First, we will use data from the APPLE NYC cohort, measure associations between social and built environment and longitudinal T2DM outcomes after GDM we will explore the lived experiences of women of color in the years following a GDM pregnancy by in-depth i nterviews with Black, Latina, and South Asian women who experienced GDM during including those who have and have not progressed to T2DM, up to 10 years postpartum. Finally, will develop an agent-based model to assess and compare potential policy interventions to improve T2DM after GDM and reduce racial-ethnic disparities. To do o we will identify a set of policy scenarios to structural inequities in the social and built environment, use the agent-based model to assess the impact the risk of T2DM inequities, estimate policy cost, and conduct cost effectiveness analyses. We will utilize APPLE NYC cohort t o validate the model. Our proposed study not only fills gaps in targeted research in the of T2DM, but also shifts the paradigm of post-GDM T2DM prevention to an ecosocia l framework. findings will be a key resource for policymakers on how to disrupt progression from GDM to T2DM and life course racial-ethnic inequities. a p . s