Where the Food Is : Diabetes in Pregnancy and Proximity to Healthy and Unhealthy Food Sources in the Bronx

Objective: To assess the relationship between walkable access to healthy and unhealthy food sources and risk of diabetes in pregnancy. Methods: Patient medical records were utilized to develop a cohort of obstetric patients who resided in Bronx, NY and initiated prenatal care in one calendar year. Locations of both healthy and unhealthy food sources (HFS and UFS, respectively) were derived from a combination of databases. Street network analysis was performed to identify stores within walking distance from each patient’s geocoded residence. The odds of diabetes during pregnancy were obtained through logistic regression to determine the effect of walkable access to both HFS and UFS after adjusting for other patient-level covariables. Results: A cohort of 4,833 records was created. For all patients, proximity to a UFS was not associated with increased risk of diabetes in pregnancy. For lower-income patients, as indicated by Medicaid coverage or uninsured status, those who lived further than 0.25 miles from a HFS showed increased odds of diabetes during pregnancy although this association was not statistically significant at the a = 0.05 level (adjusted OR = 1.32, 95% CI 0.94-1.84). Patients with commercial insurance who lived farther than 0.25 miles from a HFS had statistically significant decreased odds of gestational diabetes (adjusted OR = 0.77, 95% CI 0.59-0.99). Conclusions: Socioeconomic status appears to modify the effect of walkable street distance on the risk of diabetes during pregnancy in an urban environment.