90 - Association of Community Walkability and Glycemic Control among Pregnant Individuals with Pregestational Diabetes

Saturday, February 11, 2023

9:30 AM – 9:45 AM

Location: Room 3018, Moscone West, Level 3

Objective:

To evaluate the association between community walkability and glycemic control as measured by hemoglobin A1c (A1c) among pregnant individuals with pregestational diabetes.

Study Design: A retrospective analysis of pregnant individuals with pregestational diabetes from 2012-2016 enrolled in an integrated prenatal and diabetes care program. Participant addresses were geocoded and linked at the census tract. The exposure was community walkability by the U.S. Environmental Protection Agency (EPA) National Walkability Score (score range 1-20), which incorporates intersection density (design), proximity to transit stops (distance), and a mix of employment and household types (diversity). Individuals from neighborhoods that were the most walkable (score 15.3-20.0) were compared with those from neighborhoods that were less walkable (score < 15.3) per EPA recommendations. The outcomes were A1c < 6.0% and < 6.5% in early and late pregnancy, and mean change in A1c across pregnancy. Modified Poisson regression and linear regression were used.

Results: Among 417 pregnant individuals (33% type 1, 67% type 2 diabetes), the mean walkability score was 10.1 (SD: 4.04), and 10% were living in the most walkable communities. Individuals were assessed in early pregnancy (median gestational age: 9.7 weeks), and a subset of 376/417 in late pregnancy (median gestational age: 30.4 weeks). Pregnant individuals living in the most walkable communities were more likely to have an A1c < 6.0% in early pregnancy (15% vs. 8%; aRR: 1.46; 95% CI: 1.00-2.16), as well as an A1c < 6.5% in late pregnancy compared to those living in less walkable communities (13% vs. 9%; aRR: 1.33; 95% CI: 1.08-1.63) (Figure; Table). There was no statistical difference in A1c < 6.5% in early pregnancy, A1c < 6.0% in late pregnancy, and percentage change in A1c by walkability status.

Conclusion: Pregnant individuals with pregestational diabetes living in communities with better walkability had better glycemic control. Whether lifestyle interventions that target the neighborhood environment can improve glycemic control in pregnancy requires further study.

Presenting Author(s)

Christine P. Field, MD, MPH (she/her/hers)

Maternal Fetal Medicine Fellow
Ohio State University / Department of OB/GYN / Division of Maternal Fetal Medicine
Columbus, Ohio, United States

Slides

Coauthor(s)

Courtney Denning-Johnson Lynch, MPH, PhD

Associate Professor, Obstetrics & Gynecology and Epidemiology
The Ohio State University
Columbus, Ohio, United States
NF

Naleef Fareed, MBA, PhD

The Ohio State University
Columbus, Ohio, United States
JJ

Joshua Joseph, MD

The Ohio State University
Columbus, OH, United States
JW

Jiquiang Wu, MSc

The Ohio State University Wexner Medical Center
The Ohio State University Wexner Medical Center, OH, United States
ST

Stephen Thung, MD, MSCI

Clinical Professor of Obstetrics and Gynecology
The Ohio State University
Columbus, OH, United States
SG

Steven Gabbe, MD

The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Mark B. Landon, MD

Richard L. Meiling Professor and Chair, Obstetrics and Gynecology
The Ohio State University
Columbus, Ohio, United States
William A. Grobman, MD, MBA

Vice Chair, Clinical Operations, Maternal Fetal Medicine
The Ohio State University
Columbus, Ohio, United States

Primary Author(s)

Kartik Kailas Venkatesh, MD, PhD (he/him/his)

Assistant Professor
The Ohio State University
Columbus, Ohio, United States