A new study led by the UC Irvine Joe C. Wen School of Population & Public Health reveals a connection between historic redlining and gestational diabetes mellitus (GDM). The research, published in Diabetes Care, shows that pregnant individuals living in formerly redlined neighborhoods are significantly more likely to develop GDM.
Redlining, a form of structural racism practiced in the 1930s by the federal Homeowners’ Loan Corporation (HOLC), assigned neighborhoods grades, often discriminating against communities of color. These maps directly influenced disinvestment in communities, which affects long-term access to crucial resources like health care, education, and nutritious food.
The research team analyzed over 86,000 pregnancies from 2008 to 2018 using Kaiser Permanente Southern California’s health records. Researchers geocoded patients’ addresses and overlaid them onto digitized HOLC maps. They then evaluated the association between redlining grades and GDM diagnoses, factoring in maternal characteristics, including age, education, race and ethnicity, and smoking status.
The study found that pregnant individuals residing in lower-graded areas were significantly more likely to develop GDM. Compared to those living in the highest-rated A zones, the odds of developing GDM were 1.22 times higher in C-graded zones and 1.30 times higher in D-graded zones. Researchers also found that the body mass index (BMI) accounted for 44.2% and area deprivation index (ADI) for 64.5% of the increased risk. This suggests that the long-term impacts of neighborhood deprivation and limited access to healthy food, exercise spaces, and preventative care play an imperative role in maternal health disparities.
“Our findings suggest that both maternal BMI and neighborhood deprivation are potential pathways linking historical redlining to GDM. This information could be helpful for developing health care and community-level interventions,” said Wajeeha Umer, MPhil, first author and a current doctoral student in Environmental Health Sciences.
To remedy this issue, healthcare providers should prioritize obesity prevention and consider neighborhood deprivation in GDM risk assessments. Understanding how neighborhood conditions and systemic inequities influence diseases is key to creating more equitable health interventions.
By understanding these pathways, we can better help tailoring public health interventions to support maternal health in underserved communities.”
–Wajeeha Umer, MPhil, first author
“By understanding these pathways, we can better help tailoring public health interventions to support maternal health in underserved communities,” said Umer.
Additional authors include Jun Wu, corresponding author and professor of environmental and occupational health; Karen D. Lincoln, professor of environmental and occupational health; Yi Sun and Anqi Jiao, former graduate student researchers; and Mengyi Li, a PhD candidate, all from UC Irvine Wen Public Health; Darios Getahun, Chantal C. Avila, Vicki Y. Chiu, Jeff M. Slezak, and David A. Sacks, all from Kaiser Permanente Southern California Department of Research & Evaluation; John Molitor from Oregon State University; Tarik Benmarhnia from the University of California, San Diego; Jiu-Chiuan Chen from the University of Southern California. Dr. Getahun is also affiliated with the Kaiser Permanente Bernard J. Tyson School of Medicine.
