Association of Historical Redlining With Gestational Diabetes Mellitus: The Mediating Role of BMI and Area Deprivation Index

• DOI: 10.2337/dc24-2147
• Publication Date: 2025-02-12T16:34:26Z
• Authors: Wajeeha Umer; Yi Sun; Anqi Jiao; Karen D. Lincoln; Mengyi Li; Chantal C. Avila; Vicki Y. Chiu; Jeff M. Slezak; David A. Sacks; John Molitor; Tarik Benmarhnia; Jiu-Chiuan Chen; Darios Getahun; Jun Wu
• Keywords: Social Deprivation

OBJECTIVE We investigated the association between historic redlining and risk of gestational diabetes mellitus (GDM), whether this relationship is mediated by maternal obesity area-level deprivation. RESEARCH DESIGN AND METHODS This retrospective study included 86,834 singleton pregnancies from Kaiser Permanente Southern California’s health records (2008–2018). Redlining was assessed using digitized Home Owners’ Loan Corporation (HOLC) maps, with patients’ residential addresses geocoded assigned HOLC grades (A, B, C, or D) based on their geographic location within HOLC-graded zones. For GDM case patients, exposure address at diagnosis date; for noncase it during 24th to 28th week. Health were combined area deprivation index (ADI) 2011 2015 census data. Mixed-effect logistic regression models associations GDM, mediation BMI ADI evaluated inverse odds ratio weighting. Models adjusted age, education, race ethnicity, neighborhood-level income, smoking status. RESULTS Among 10,134 (11.67%) we found increased in B (“still desirable,” [aOR] 1.20, 95% CI 0.99–1.44), C-graded (“definitely declining,” aOR 1.22, 1.02–1.47), D-graded (“hazardous,” i.e., redlined, 1.30, 1.08–1.57) neighborhoods compared “best”-graded zone. Prepregnancy 44.2% 64.5% among mothers redlined areas. CONCLUSIONS Historic associated an neighborhood Future research needed explore complex pathways linking pregnancy outcomes.