NEIGHBORHOOD CHARACTERISTICS AND RISK OF GESTATIONAL DIABETES IN NEW YORK CITY

描述（由申请人提供）：妊娠期糖尿病的发病率正在增加，其特征是妊娠期间发生的葡萄糖耐受不良。饮食、体力活动和肥胖是与妊娠期糖尿病有关的可改变的危险因素。同时，人们对肥胖症的增加感到担忧，这激发了人们对识别可能影响个人行为的肥胖症环境决定因素的兴趣，包括一个人生活的社区的特征。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用性。另一个社区特征是种族集中。南亚，拉丁美洲，非洲和加勒比海地区的妇女患妊娠糖尿病的风险增加，特别是那些在国外出生的妇女。有人认为，移民妇女中发现的这种增加的风险可能部分是由于移民后饮食和生活方式的改变。因此，对于移民妇女来说，生活在种族飞地之外可能会增加她们患妊娠糖尿病的风险，因为她们的饮食和生活方式会发生更大的变化，同时社会和工具支持会减少。使用关联的纽约市出院、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期糖尿病风险之间的关联。以下研究问题将使用控制潜在个体水平的多水平模型来解决（教育，种族，平等，年龄，医疗补助状况）和社区水平（剥夺）混杂因素：1）贫困的社区食品环境评分，定义为超市，快餐店，水果和蔬菜摊位和天然食品商店的数量的组合，与妊娠糖尿病的高风险相关吗？2)这种联系的强度是否因母亲的教育水平和就业状况而异？3）纽约市七个移民群体的社区饮食环境、种族集中度与GDM之间的关系是什么？患有妊娠期糖尿病的母亲的婴儿在出生时发生并发症的风险更大，包括巨大儿和分娩期间的创伤。他们在儿童和青少年时期患肥胖症、葡萄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，沿着风险的种族差异，更多地了解妊娠期糖尿病的背景风险因素对于实现CDC促进健康妊娠和分娩结局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，它解决了女性居住的社区如何影响她们在怀孕期间发生重要并发症的风险。社区食物环境和种族集中度与妊娠期糖尿病相关的信息可以支持健康社区的设计，通过鼓励健康行为，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.