The Relationship of Food Insecurity, Neighborhood Characteristics, and Gestational Diabetes Self-Management
Authors:   , Birati Yosefa , Bloch Joan R 
Published: April 2022

Diabetes during pregnancy is a leading cause of maternal health concerns with significant risk of adverse perinatal outcomes and long-term health complications for affected pregnant patients and their offspring. Self-care behaviors include following a prescribed diet, glucose self-monitoring, regular physical exercise, and adequate glycemic control are essential in preventing unfavorable maternal-infant health outcomes. There is evidence that factors that disrupt proper diabetes self-management and prevent dietary needs from being met is food insecurity and the neighborhood-built environment among non-pregnant populations. Yet, the issue of food insecurity and diabetes self-management among pregnant patients in research is relatively unexplored and warranted since the importance of glycemic control is critical to maternal-fetal health during pregnancy. Thus, the purpose of this study was to examine the relationship between food insecurity, neighborhood characteristics, and diabetes self-management among low-income urban pregnant patients. The research design relied on two quantitative research designs. The first research design was a secondary analysis of existing clinical data obtained from a REDCap research database of Philadelphia Pregnancy and Diabetes Home Visiting database (n=264). The second research design was a cross-sectional study that collected primary data in a prenatal clinic from patients with GDM (n=17). In part I of the study glycemic control was categorized in three distinct ways from subject's health records that were part of a clinical research database and neighborhood-level data sources. Access to healthy food and poverty were identified by using PolicyMap, a geographic information system. Univariate and multivariate logistic regression analyses were conducted. In part II of the study, food insecurity, subjective perceptions of the built environment of the neighborhoods where the participants resided, and their diabetes self-management was examined. Independent sample t-tests were conducted. The results from part I of the study showed no relationship between living in neighborhood with low access to healthy food, neighborhood poverty and glycemic control. Yet, at the individual level, utilization of the services of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) emerged as a significant factor for glycemic control (p = .034) and subjects who reported they used WIC services were two times more likely to achieve glycemic control than those who did not use WIC services. Findings from part II of the study showed food-insecure participants perceived their neighborhood characteristics as more disadvantaged compared to those who were not food insecure. Statistically significantly differences were found in their perception on the neighborhood aesthetic quality (t[15] = 5.98, p < .001); walking and exercise environment (t[15] = 3.46, p = .003); and safety from crime and violence (t[15] = 2.82, p = .013). Also, food insecure participants had lower diabetes self-management perception scores (mean = 5.25, SD =1.54) compared to not-food-insecure participants (mean = 7.12, SD = .97); (t[15]= -3; p = .009). The conclusions of this study are that multilevel factors such as the neighborhood-built environment and individual factors are important areas to better understand the influences on glycemic control among pregnant women. Research is needed to develop methods to help categorize glycemic control from patient generated blood glucose data that are recorded in prenatal health records.