Introduction and Objective: Gestational diabetes mellitus (GDM) may be shaped by food access barriers at both neighborhood and individual levels. We examined how neighborhood food access and individual food insecurity (FI) may jointly influence GDM risk, and whether federal food assistance mitigates this risk. Methods: We conducted a population-based cohort study of 13,927 pregnant individuals at Kaiser Permanente Northern California in 2020-2022. Neighborhood food access was assessed using USDA’s census tract-level low-income, low-food access (LILA) indicator at pregnancy onset. FI in pregnancy was assessed via a validated two-item screener. Using adjusted Poisson regression, we estimated relative risks (RRs) and 95% CIs for GDM comparing individuals with LILA only, FI only, both, or neither. Results: Overall, 15.6% of pregnant individuals lived in LILA neighborhoods, 9.0% reported FI, and 3.7% had both. Compared with neither exposure, LILA only was modestly associated with GDM (RR 1.15 95% CI 0.98-1.34), while FI only (1.47 1.23-1.77) and both LILA-FI (1.39 1.04-1.86) showed stronger associations (Figure). Associations were attenuated to null among those who received federal food assistance in pregnancy and persisted for non-recipients (FI only: 1.52 1.25-1.85; both LILA-FI: 1.46 1.06-2.01). Conclusion: Neighborhood and individual FI were associated with higher GDM risk, with receipt of federal food assistance potentially mitigating this risk. Disclosure R. Chehab: None. A. Ngo: None. M. Greenberg: None. L. Chen: None. A. Ferrara: None. Y. Zhu: None. Funding National Institutes of Health (K99HD115836)
Chehab et al. (Fri,) studied this question.