In a growing body of evidence of social factors influencing health, Kaiser Permanente researchers have found that where you live affects the likelihood of developing diabetes in pregnancy.

A study from earlier this year in the journal Obstetrics & Gynecology from the Kaiser Permanente Division of Research had two major findings:

• There’s a connection between gestational diabetes and pregnant patients living in economically and socially deprived neighborhoods.
• The likelihood of developing gestational diabetes increases the more deprived a neighborhood is.

Gestational diabetes is a disease that can lead to serious health risks for both mother and baby during the pregnancy and raises the likelihood of long-term health issues after birth for both mom and child.

The study accounted for known risk factors of gestational diabetes, and still showed a major role for neighborhood deprivation, said the study’s lead author Emily Liu, MPH, a programmer analyst with the Kaiser Permanente Division of Research who is pursuing a PhD in epidemiology.

“We looked at this relationship in many different ways,” Liu said. “And we found that the results were still robust, showing the risk increased with higher deprivation.”

Neighborhood is a key risk factor

The researchers used a neighborhood deprivation index that measures socioeconomic status using 8 different metrics, including households in poverty, rates of crowded housing and unemployment, and education levels of residents.

While other studies have shown race and ethnicity are associated with gestational diabetes, this research did not find significant differences by race and ethnicity in the relationship between neighborhood deprivation and gestational diabetes risk.

“But it seems that, in addition to racial and ethnic group, neighborhood is also a really important factor in gestational diabetes risk,” said study senior author Monique Hedderson, PhD, a research scientist with the Division of Research. “These findings were consistent across racial and ethnic groups.”

The analysis included 214,375 pregnancies among Kaiser Permanente Northern California members, and about 11% of them had gestational diabetes. Prevalence of the condition ranged from 10% in the least deprived areas to 12.7% in the most deprived.

The role of social drivers in heath

The researchers looked at factors that might mediate, or explain, the increased risk of gestational diabetes.  

They include pre-pregnancy BMI, weight gain during pregnancy, smoking, and illegal drug use. About half of the increased risk may be explained by patients with overweight or obesity, a major risk factor for gestational diabetes. The other factors contributed little or not at all to the results.

The authors said their analysis did not identify what specifically about a deprived neighborhood might increase the disease risk.

“There are many factors that might be involved, including access to healthy food, safety and walkability to get exercise, and/or stress,” Hedderson said. “That would be something for future research to explore.”

The results add to the mounting evidence on how factors outside the health care system influence health outcomes, said study co-author Mara Greenberg, MD, a maternal fetal medicine specialist and co-director of the Kaiser Permanente Regional Perinatal Service Center.

“This adds to our growing understanding of the way social drivers of health can have intergenerational effects on families,” Dr. Greenberg said. “Gestational diabetes affects moms’ health as well as that of their children. The effects of that condition can extend into childhood and beyond, raising risk of obesity, diabetes, and other health conditions.”

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