Associations of the Neighborhood Built Environment with Gestational Weight Gain

Abstract

Objective This study aimed to determine whether specific factors of the built environment related to physical activity and diet are associated with inadequate and excessive gestational weight gain (GWG). Study Design This analysis is based on data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous women who were followed from the beginning of their pregnancies through delivery. At each study visit, home addresses were recorded and geocoded. Locations were linked to several built-environment characteristics such as the census tract National Walkability Score (the 2010 Walkability Index) and the number of gyms, parks, and grocery stores within a 3-km radius of residential address. The primary outcome of GWG (calculated as the difference between prepregnancy weight and weight at delivery) was categorized as inadequate, appropriate, or excessive based on weight gained per week of gestation. Multinomial regression (generalized logit) models evaluated the relationship between each factor in the built environment and excessive or inadequate GWG. Results Of the 8,182 women in the analytic sample, 5,819 (71.1%) had excessive GWG, 1,426 (17.4%) had appropriate GWG, and 937 (11.5%) had inadequate GWG. For the majority of variables examined, built environments more conducive to physical activity and healthful food availability were associated with a lower odds of excessive or inadequate GWG category. For example, a higher number of gyms or parks within 3 km of a participant's residential address was associated with lower odds of having excessive (gyms: adjusted odds ratio [aOR] = 0.93 [0.89–0.96], parks: 0.94 [0.90–0.98]) or inadequate GWG (gyms: 0.91 [0.86–0.96]; parks: 0.91 [0.86–0.97]). Similarly, a higher number of grocery stores was associated with lower odds of having excessive GWG (0.94 [0.91–0.97]). Conclusion Among a diverse population of nulliparous women, multiple aspects of the built environment are associated with excessive and inadequate GWG. Key Points

Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes

“…Among nulliparous pregnant individuals, Grobman et al found an association between multiple aspects of the built environment, including number of gyms, parks, and grocery stores, and less gestational weight gain. 7 These findings reinforce emerging data that highlight the relationship between community-level social vulnerability to adverse perinatal outcomes. 39 In the case of diabetes in pregnancy, glycemic control requires a multimodal approach, inclusive of pharmacotherapy, frequent blood glucose checks to titrate medication, and behavioral changes inclusive of diet and exercise.…”

“…1–3 Diabetes and its risk factors disproportionately affect individuals who identify as racial or ethnic minorities and as low-income. 4,5 Social determinants of health experienced by these groups include both individual- and community-level factors, such as residence in a low-income neighborhoods, 6 built environment with less access to engage in physical activity, 7 unstable housing, 8 food insecurity, 9 lack of quality health care, 10 and experiences of systematic racism. 11 Glycemic control, which can be measured using glycosylated hemoglobin A 1c (Hb A 1c ), is affected by social determinants of health.…”