Neighborhood Factors Affect Early Pregnancy Metabolic Health

A recent study in the International Journal of Environmental Research and Public Health adds to growing evidence that environmental factors such as housing quality, access to grocery stores and poverty contribute to perinatal health inequity.

“We looked at how neighborhood deprivation was associated with impaired glucose intolerance and obesity and we found that higher neighborhood deprivation increased the odds of having glucose intolerance by about 15% and the odds of having obesity by almost 40%,” says Cara Dolin, MD, a maternal-fetal medicine specialist at Cleveland Clinic and lead author of the study.

Study inception, design and methods

Dr. Dolin developed an early interest in nutrition and pregnancy. She earned an undergraduate degree in nutrition and food science and a master’s degree in public health nutrition during her fellowship at New York University Medical Center.

“A lot of my clinical work and academic research is around how we can optimize women’s health from preconception through pregnancy and postpartum through healthy lifestyle, nutritious food and physical activity,” says Dr. Dolin, who leads Cleveland Clinic’s Diabetes and Pregnancy programs along with Stacey Ehrenberg, MD. 

In her recent study, Dr. Dolin collaborated with colleagues from the University of Pennsylvania on a retrospective cohort study of non-diabetic patients with singleton births ≥ 20 weeks’ gestation in two Philadelphia hospitals between 2017 and 2019. They examined data for more than 10,000 patients derived from GeoBirth, a curated pregnancy cohort of all births at the two hospitals ongoing since 2008.

“We used geospatial research methods to connect health information with information about where people live,” says Dr. Dolin. The team also used a census tract neighborhood deprivation index.

The researchers studied patients with impaired glucose intolerance, defined as an HbA1c of 5.7% to 6.4%.

“Patients who already have a diagnosis of diabetes going into pregnancy are often hooked into the healthcare system, have had some education and are managing the condition,” says Dr. Dolin. “But there are patients with prediabetes who are on a continuum of risk when it comes to cardiometabolic health.”

Findings highlight racial disparities

The team examined patients’ impaired glucose intolerance, obesity and the interaction between the two. They split the group into Black and white patients to better understand racial disparities and social determinants of health.

Primary findings included the following:

• Overall, 11% of patients had impaired glucose intolerance – 16% of Black patients compared to 3% of white patients.
• The rate of obesity was 45% in Black patients compared to 16% in white patients.
• Mean neighborhood deprivation (range 0 – 1, higher indicating more deprivation) was higher among Black patients (0.55) compared with white patients (0.36).

“We did a mediation analysis to understand the effect of neighborhood deprivation and found that 13% of the Black/white disparity that was seen in impaired glucose intolerance can be explained by the neighborhood,” says Dr. Dolin.

Making a difference for individuals and communities

“In medicine and research, we are always looking at patients’ individual factors – age, chronic conditions, smoking status, level of exercise. But here, we took a broader look,” she says. “How can we improve the health of our communities so that downstream it improves the health of our patients?”

Dr. Dolin encourages physicians to screen patients for social determinants of health, such as food insecurity. In addition, she advocates for expanding considerations in patient care to include neighborhoods.

“That doesn’t mean you have to be able to solve every problem, but you can then refer appropriately,” she says. “Give them information about the local food bank and benefits available from the Women, Infants & Children program and the Supplemental Nutrition Assistance Program.”

Dr. Dolin hopes that work she and others are doing at the community level will help to inform public health initiatives focused on improving neighborhoods and decreasing perinatal health inequities.