The Association Between Neighborhood Deprivation and Perinatal Cardiometabolic Outcomes, 2016 – 2019 Open Access

Abstract

Background: Hypertensive disorders of pregnancy and gestational diabetes are leading contributors to mother and infant morbidity and mortality. Studies have indicated that neighborhood-level factors may increase the risk of developing a hypertensive disorder of pregnancy or gestational diabetes. This study investigated the effect of neighborhood deprivation on the odds of having a hypertensive disorder of pregnancy or gestational diabetes.

Methods: Data was obtained from the Georgia MCH Data Repository, which includes linked birth certificate data and publicly accessible Census data from 2016 – 2019 with neighborhood deprivation index (NDI) values. Logistic regress was performed using SAS procedures.

Results: The final dataset contained 350,369 observations. In the study population, 23,735 women (6.77%) had HDP, and 16,249 women (4.64%) had GD. The crude odds ratio for a 1 SD increase in NDI and HDP was 1.13 (95% CI: 1.12, 1.15) and 1.00 (95% CI: 0.98, 1.02) for a 1 SD increase in NDI and GD. There was significant statistical interaction on the multiplicative scale for NDI and maternal age. For HDP, at 18 years for maternal age, the aOR was 1.05 (95% CI: 1.02, 1.08), at 28 years, the aOR was 1.16 (95% CI: 1.14, 1.18), and at 38 years, the aOR was 1.28 (95% CI: 1.25, 1.32). For GD, at 18 years for maternal age, the aOR was 0.99 (95% CI: 0.94, 1.03), at 28 years, the aOR was 1.08 (95% CI: 1.06, 1.11), and at 38 years, the aOR was 1.19 (95% CI: 1.16, 1.23). No interaction was found by racial/ethnic groups or income. 

Conclusion: High neighborhood deprivation is associated with increased odds of developing a hypertensive disorder of pregnancy or gestational diabetes, particularly among older women. Programs and interventions should be aimed at older women living in high deprivation neighborhoods. 

Table of Contents

Literature Review………………………………………..…………………...………………......1

Summary…………………………………………….……………………………...............1

Perinatal Cardiometabolic Outcomes……………………………….………………........2

Hypertensive Disorders of Pregnancy…………………………………………............2

Gestational Diabetes…………………………………………………………...…...........4

Neighborhood Deprivation……………………………………………………………….....5

Neighborhood Deprivation and Health…………………………………………......…6

Neighborhood Deprivation and Birth Outcomes……………………..………..…....8

Neighborhood Deprivation and Perinatal Cardiometabolic Outcomes.……......9

Standardized Neighborhood Deprivation Index..……………………………........10

Study Objectives.……………………………………………………………………..…......11

Methods………………………………………………………………………...…………..…….13

Study Design……………………………………………………………………………........13

Study Population……………………………………………………………………..…......13

Measures and Variables…………………………………………………………….……....14

Outcome Variables…………………………………………………………...…............14

Exposure Variable……………………………………...……………………...........…..14

Causal Diagrams………………………………………….………………….….............15

Covariates……………………………………….…………………………...…..............17

Potential Interactions…………………………………….…………………..…..........19

Data Analysis………………………………………………………………….……….......…20

Results…………………………………………………………………………...………….….…22

Descriptive Statistics…………………………………………………………………….....22

Model Results………………………………………………………………………….........25

Model Fit………………………………………………………………………………….......27

Discussion……………………………………………………………………………………..…28

Strengths and Limitations………………………………………………………………...30

Public Health Implications and Future Directions……………………………...…..31

References………………………………………………………………………………...…....33

Tables and Figures…………………………………………………………………………..…46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	gestational diabetes perinatal epidemiology neighborhood deprivation neighborhood neighborhood effects hypertensive disorders of pregnancy social epidemiology
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University

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