Neighborhood Food Environments and Incidence of Type 2 Diabetes after Gestational Diabetes: A Population-Based Cohort Study in New York City

Introduction and Objective: A healthy diet is key for preventing type 2 diabetes (T2D) after gestational diabetes mellitus (GDM). Poor access to healthy food may pose barriers to healthy eating postpartum. We evaluated whether residential neighborhood food environments were associated with T2D incidence after GDM and whether neighborhood economic deprivation (NED) modified associations. Methods: We used data from the A1c in Pregnancy and Postpartum Linkage for Equity (APPLE) NYC Cohort, a multi-ethnic postpartum cohort of women with GDM, constructed by linking 2009-2011 birth, hospital discharge, and 2009-2021 A1c Registry data. Those with diabetes diagnosed pre-pregnancy or in the first trimester were excluded. T2D incidence was defined as two A1c results ≥6.5% after 12 weeks postpartum. Neighborhoods were defined as census blocks with 1 km buffers around participants’ home addresses, which were linked to proprietary and public data to characterize NED and the food environment. As in previous work, densities of BMI-healthy food outlets (supermarkets, fruit/vegetable markets, and natural food stores) were calculated and modeled as quartiles (higher quartiles=healthier food environments). Cox proportional hazards models estimated associations between food environments and T2D risk, adjusting for maternal age, race and ethnicity, education, nativity, parity, and NED. Survival time in years was calculated as the duration between 12 weeks postpartum and the date of T2D onset. Results: Among 12,024 women with GDM, the 12-year cumulative incidence of T2D was 20.1%. Compared to neighborhoods with the healthiest food environments (Q4), all 3 lower quartiles were significantly associated with a higher risk of T2D (e.g. Q1: Adjusted hazard ratio= 1.19; 95% Confidence interval=1.03, 1.38). Associations were strongest for women living in the least economically deprived neighborhoods. Conclusion: Living in neighborhoods with healthier food environments was associated with a lower risk of T2D after GDM. Disclosure: S.S. Albrecht: None. B. Wu: None. T. Janevic: None. Funding: NIDDK R01DK134725