Perinatal & Pediatric
Association between density of food retailers and fitness centers and gestational diabetes mellitus in Eastern Massachusetts Matthew Shupler* Stefania Papatheodorou Matthew Shupler Jochem Klompmaker Michael Leung Joshua Petimar Jean-Philippe Drouin-Chartier Peter James Anna Modest Michele Hacker
Background: Few studies have investigated the association between the food and physical activity environment with the risk of gestational diabetes mellitus (GDM) with conflicting results.
Methods: Medical records from 68,779 pregnant individuals living in Eastern Massachusetts from 2000-2016 were linked by residential address to the density of supermarkets, fast-food restaurants, full-service restaurants, convenience stores, and fitness centers at 500-, 1000- and 1500-meter (m) buffers. Two indices (‘healthy food index’; ‘restaurant ratio’) assessed the relative availability of healthy versus unhealthy food retailers. Multivariable logistic regression quantified the association between exposure variables and GDM odds, adjusting for individual and area-level characteristics. Effect modification by socioeconomic status (SES) was assessed using the Area Development Index (ADI).
Findings: In the fully adjusted model, pregnant individuals living in areas with the highest density of fast-food restaurants had higher odds of GDM compared to individuals living in areas with the lowest density (500 m (odds ratio (OR):1.17 95%CI:[1.04,1.34]), 1000 m (1.36 95%CI:[1.16,1.59]), and 1500 m (1.15 95%CI:[0.97,1.36]). While other exposure variables were not associated with GDM odds, there was significant effect modification by ADI. Among participants living in the lowest SES (highest ADI) neighborhoods, those living in the highest supermarket density tertile had significantly lower odds of GDM at all buffers (500 m; 1000 m; 1500 m. The association between fast-food restaurant density with GDM odds was greater in lower SES areas.
Interpretation: A greater number of fast-food establishments, particularly in low SES neighborhoods, and a lower density of supermarkets in high SES areas were associated with higher GDM risk in Eastern Massachusetts.
