(OR18-05-26) Neighborhood Food Access and Adverse Pregnancy Outcomes: A Population-Based Longitudinal Cohort Study

Objectives: Neighborhood food access is a structural determinant of maternal health that may influence pregnancy and long-term cardiovascular risk, yet this relationship is poorly characterized. We examined associations between periconceptional residence in low-income, low-food-access (LILA) neighborhoods and adverse pregnancy outcomes (APO).

Methods: We conducted a population-based cohort study of 326,748 pregnant women receiving prenatal care in Kaiser Permanente Northern California (2011–2022). We excluded non-singleton pregnancies and women with pre-existing diabetes or hypertension. The exposure was periconceptional residence (1 year before last menstrual period through 20 weeks’ gestation) in a LILA neighborhood, defined by USDA as a low-income census tract with low food access ( >0.5 miles to a supermarket in urban areas or >10 miles in rural areas). Outcomes included gestational diabetes (GDM), gestational hypertension (GHTN), preeclampsia/eclampsia (PE/E), preterm birth, small-for-gestational-age birth (SGA), and composite APO, identified from electronic health records. Adjusted relative risks (aRRs) and 95% confidence intervals (CIs) were estimated using generalized estimating equations accounting for census-tract-level clustering.

Results: Overall, 25.1% of women resided in LILA neighborhoods. In models adjusted for demographic (age at delivery, parity) and behavioral factors (smoking, alcohol use), LILA residence was associated with elevated risk of GDM (aRR 1.23 [95% CI 1.18–1.28]), PE/E (1.16 [1.12–1.21]), preterm birth (1.12 [1.08–1.16]), and GHTN (1.06 [1.02–1.09]), with smaller associations for SGA (1.03 [1.00–1.06]). Risk of APO was 9% higher among women residing in LILA neighborhoods (1.09 [1.07–1.11]). After additional adjustment for socioeconomic factors (education and prenatal insurance type), associations attenuated slightly and remained significant for GDM (1.18 [1.13–1.22]), PE/E (1.12 [1.07–1.17]), preterm birth (1.08 [1.05–1.12]), and APO (1.06 [1.05–1.08]).

Conclusions: Periconceptional residence in LILA neighborhoods was associated with elevated risk of multiple APO. These findings suggest neighborhood food access as a modifiable structural determinant of health and support neighborhood-level screening and interventions to improve maternal and neonatal outcomes.

Funding Sources: NIH