title: Geospatial analysis of food environment demonstrates associations with gestational diabetes.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM) is one of most common complications of pregnancy, with incidence rates varying by maternal age, race/ethnicity, obesity, parity, and family history. Given its increasing prevalence in recent decades, covariant environmental and sociodemographic factors may be additional determinants of GDM occurrence.
  
  
  OBJECTIVE
  We hypothesized that environmental risk factors, in particular measures of the food environment, may be a diabetes contributor. We employed geospatial modeling in a populous US county to characterize the association of the relative availability of fast food restaurants and supermarkets to GDM.
  
  
  METHODS
  Utilizing a perinatal database with >4900 encoded antenatal and outcome variables inclusive of ZIP code data, 8912 consecutive pregnancies were analyzed for correlations between GDM and food environment based on countywide food permit registration data. Linkage between pregnancies and food environment was achieved on the basis of validated 5-digit ZIP code data. The prevalence of supermarkets and fast food restaurants per 100,000 inhabitants for each ZIP code were gathered from publicly available food permit sources. To independently authenticate our findings with objective data, we measured hemoglobin A1c levels as a function of geospatial distribution of food environment in a matched subset (n = 80).
  
  
  RESULTS
  Residence in neighborhoods with a high prevalence of fast food restaurants (fourth quartile) was significantly associated with an increased risk of developing GDM (relative to first quartile: adjusted odds ratio, 1.63; 95% confidence interval, 1.21-2.19). In multivariate analysis, this association held true after controlling for potential confounders (P = .002). Measurement of hemoglobin A1c levels in a matched subset were significantly increased in association with residence in a ZIP code with a higher fast food/supermarket ratio (n = 80, r = 0.251 P < .05).
  
  
  CONCLUSIONS
  As demonstrated by geospatial analysis, a relationship of food environment and risk for gestational diabetes was identified.
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Maike K
authors: MK
authors: Kahr
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Melissa A
authors: MA
authors: Suter
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Jerasimos
authors: J
authors: Ballas
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Susan M
authors: SM
authors: Ramin
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Manju
authors: M
authors: Monga
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Wesley
authors: W
authors: Lee
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Min
authors: M
authors: Hu
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Cindy D
authors: CD
authors: Shope
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Arina
authors: A
authors: Chesnokova
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Laura
authors: L
authors: Krannich
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Emily N
authors: EN
authors: Griffin
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Joan
authors: J
authors: Mastrobattista
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Gary A
authors: GA
authors: Dildy
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors: Stacy L
authors: SL
authors: Strehlow
authors: Environmental Health Section, Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Houston, TX.
authors: Ryan
authors: R
authors: Ramphul
authors: Environmental Health Section, Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Houston, TX.
authors: Winifred J
authors: WJ
authors: Hamilton
authors: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX. Electronic address: aagaardt@bcm.edu.
authors: Kjersti M
authors: KM
authors: Aagaard
mesh_terms: D000328:Adult; D003132:Commerce / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000097:blood / Q000453:epidemiology*; D004779:Environment Design; D057140:Fast Foods / Q000600:supply & distribution*; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D040362:Geographic Information Systems; D062305:Geographic Mapping; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D011247:Pregnancy; D012111:Residence Characteristics; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: food environment; geospatial analysis; gestational diabetes; neighborhood; pregnancy outcome