Perinatal & Pediatric
Neighborhood food environments and perinatal cardiovascular conditions Elleni M Hailu* Elleni Hailu Hailu Hailu Hailu Stanford University School of Medicine
Neighborhood food environments have lasting impacts on various adverse health outcomes. Yet, their influence on risk of perinatal cardiovascular conditions, major drivers of maternal mortality, is understudied. We used hospital discharge data from California births occurring at ≥20 weeks’ gestation between 2010-2020 (N= 4,441,281), which was linked with United States Department of Agriculture data and the National Neighborhood Data Archive to characterize food environments. We assessed how limited food access (LFA; based on income, supermarket distance, and vehicle availability) and convenience store and fast-food outlet density per capita (high vs low tertiles) in neighborhoods (i.e. census tracts) may impact risk of hypertensive disorders of pregnancy (HDP; chronic hypertension, gestational hypertension/preeclampsia, eclampsia), HDP subtypes, and non-optimal pre-pregnancy and gestational cardiovascular health (based on hypertension, diabetes, smoking, body mass index, and gestational weight-gain). We used mixed effects modified Poisson regression models with neighborhood random intercepts and robust standard errors adjusting for sociodemographic, pregnancy, and neighborhood factors. Compared to non-LFA neighborhoods, living in LFA neighborhoods was associated with increased risk of all perinatal cardiovascular conditions, with the highest estimates observed for chronic hypertension (Risk Ratio (RR)=1.14, 95% Confidence Interval=1.10-1.18). Living in neighborhoods with high vs low convenience store density was associated with moderately elevated risk of outcomes (RR range: 1.02-1.09), while estimates comparing high vs low fast-food outlet density were attenuated. Estimates were higher when comparing living in LFA neighborhoods with high convenience store or fast-food outlet density than in non-LFA neighborhoods with low convenience store or fast-food outlet density. Findings provide evidence for promoting healthy food access to reduce perinatal cardiovascular risk.