Policy levers to reduce diabetes after gestational diabetes

Columbia University Health Sciences, New York NY

Investigators

Linked publications, trials & patents

Abstract

Updated project title: Policy levers to reduce diabetes after gestational diabetes Project Summary Gestational diabetes (GDM) is a common complication of pregnancy with substantial racial-ethnic differences. These racial-ethnic differences in GDM have profound implications for life course risk of type 2 diabetes (T2DM) and cardiovascular disease. Recently we conducted a novel data linkage between New York City birth certificate and HbA1c registry databases to construct a multiethnic population-based cohort to follow women after delivery from 2009-2017, the A1c in Pregnancy and Postpartum Linkage for Equity (APPLE) NYC Cohort. When following women with GDM, we found the 8=year incidence of diabetes after GDM was 18.5% in Black women, 16.8% in South Asian women, 14.6% in Hispanic women, 5.5% in East Asian women, and 5.4% in White women. . Despite these important findings, very little is known about what causes disparities to emerge in the years after a GDM pregnancy. Current research focuses on individual risk; however, it does not identify neighborhood contextual risk factors to inform targets for policy intervention and is not conducted in multiethnic populations. Neighborhood context may be especially potent in the postpartum period, when women often face social and economic challenges while their bodies recover and continue to evolve physiologically. Identifying policy levers to intervene "upstream” during the critical postpartum period has the potential to prevent later development of diabetes. Therefore, we propose a concurrent mixed-methods study, leveraging our retrospective cohort of 21,695 multiethnic women with GDM, the APPLE NYC Cohort, qualitative interviews with postpartum women, and an innovative systems science modeling approach. Our overall goal is to identify policy levers to prevent progression to T2DM after GDM in the postpartum periodin a multiethnic population.. First, we will use data from the APPLE NYC cohort, to measure associations between social and built environment and longitudinal T2DM outcomes after GDM. Next, we will explore the lived experiences of women in the years following a GDM pregnancy by conducting in-depth interviews with Black, Latina, and South Asian women who experienced GDM during pregnancy, including those who have and have not progressed to T2DM, up to 10 years postpartum. Finally, we will develop an agent-based model to assess and compare potential policy interventions to improve T2DM outcomes after GDM. To do so we will identify a set of policy scenarios to alter the social and built environment, use the agent-based model to assess the impact on the risk of T2DM , and then utilize the APPLE NYC cohort to validate the model. Our proposed study fills gaps in targeted research in the prevention of T2DM by shifting the paradigm of post- GDM T2DM prevention to include the neighborhood. Our findings will be a key resource for policymakers on how to disrupt progression from GDM to T2DM and reduce the overall burden of diabetes in women.