(652) Environmental protection agency (EPA) national walkability index and its impact on the severity of GDM

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Thomas Owens, MD

Dr Thomas Owens
Icahn School of Medicine at Mount Sinai West
New York, New York, United States

Coauthor(s)

JS

Johanna Suskin, MD

Mount Sinai West
New York City, New York, United States
EG

Erica Glaser, MD

Mount Sinai West
New York, New York, United States
GS

Guillaume Stoffels, MS

Statistician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Mia A. Heiligenstein, MD

Fellow
Mount Sinai West
Astoria, NY, United States
Olivia Grubman, MD

MFM Attending
Westchester Medical Center
Westchester, NY, United States
Xiteng Yan, MD (he/him/his)

Maternal Fetal Medicine Fellow
Mount Sinai West
New York, New York, United States
ZA

Zainab Al-Ibraheemi, MD

Icahn School of Medicine at Mount Sinai West
New York, New York, United States
LB

Lois Brustman, MD

Icahn School of Medicine at Mount Sinai West
New York, New York, United States

Objective: An important factor in the management of gestational diabetes (GDM) is exercise. The aim of this study is to assess neighborhood walkability and need for hypoglycemic agents (HA) in patients with GDM.

Study Design: A retrospective cohort study of pregnant patients that were diagnosed with GDM at an academic center between 2018-2023. Patients' addresses at the time of their gestation were correlated with the Environmental Protection Agency (EPA) National walkability index. The categories of EPA walkability index included:least walkable (score 1-5), below average (6-10), above average (11-15), and most walkable (16-20). A2GDM was defined as patients requiring HA. Secondary analysis included a neonatal composite outcome consisting of neonatal hypoglycemia(NH), large for gestational age(LGA), NICU admission, and APGAR score < 7. Descriptive statistics and restricted cubic spline plot (RP) were used. Multivariate analysis was conducted adjusting for median income, age, BMI, gravidity, parity, race, and hypertension.

Results: 1231 patients identified. There were 81 patients(6.6%) in the least walkable group, 225 patients(18.3%) in the below average walkable group, 428 patients(34.8%) in the above average walkable group,and 497 patients(40.4%) in the most walkable group. In multivariable analysis patients in the least walkable and below-average walkable groups had a significantly higher likelihood of having A2GDM(least walkable: p=0.004; below average walkable: p=0.02 (Table 1)). A RP showed that the relationship between walkability score and the probability of A2GDM was linear(Fig. 1).When walkability score was treated as continuous, each one-unit increase in walkability score was significantly associated with a 6% decrease in the odds of A2GDM(p=0.0001). Neonatal composite did not differ between the groups(p=0.30).

Conclusion: Patients who live in a higher walkability area are less likely to need medication. Thus, providers counseling patients with GDM should stress the importance of exercise in the control of blood glucose and its relationship to the severity and subsequent management.