Addressing racial and ethnic disparities in diabetes risk after varying glycemia levels during pregnancy - PROJECT SUMMARY/ABSTRACT Diabetes is a leading cause of mortality and morbidity in the United States. Gestational diabetes mellitus (GDM), which is diabetes that is first diagnosed and recognized during pregnancy, is a strong risk factor for future development of type 2 diabetes. In the US, a two-step diagnostic process is used to diagnose GDM: a screening test (step 1), followed by a diagnostic test (step 2), which is offered to the subset of women that fail the screening test. Only those that fail the diagnostic test are diagnosed with GDM. According to recent evidence, women that fail the screening test and have normal diagnostic test results have an intermediate level of gestational glucose intolerance (GGI), which is also a risk factor for diabetes. There are vast racial/ethnic disparities in diabetes, GDM, and GGI. It is unknown if future diabetes risk after GDM and GGI differs according to racial/ethnic groups and disaggregated subgroups (among Asian and Hispanic subgroups). Social determinants of health, which are environments where people are born, live, learn, work, play, and age, are key to addressing these disparities. Neighborhoods are considered a key social determinant. Economic disadvantages tend to cluster at the neighborhood level to cause inequitable opportunities for health improvement, adversely affecting communities of color. It is unknown if neighborhood deprivation affects risk of future diabetes after GDM or GGI. There are interventions that exist to lower future diabetes risk after GDM including screening, lifestyle, nutritional, and pharmaceutical interventions. However, there are barriers to women accessing these interventions including lack of social support and lack of frequent interactions with clinicians. Community midwifery, with its unique comprehensive perinatal care model, including up to six post- partum visits, presents an opportunity to address these barriers among individuals with GDM. Currently, there is no research assessing how community midwives support women with GDM to prevent future diabetes. Thus, the main goal of my study is to identify opportunities to address racial/ethnic disparities in diabetes after GDM and GGI. The specific aims are to: Aim 1) Ascertain risk of future diabetes after GDM and GGI overall, and by racial/ethnic groups and disaggregated Asian and Hispanic subgroups; Aim 2) Investigate if risk of future diabetes after GDM and GGI is modified by levels of neighborhood level deprivation, overall, and by racial/ethnic groups and disaggregated subgroups; and Aim 3) Assess how community midwifery care supports individuals with GDM during the perinatal period to lower their future diabetes risk, especially among historically minoritized racial/ethnic subgroups. Findings from this research may identify racial/ethnic groups and subgroups at high risk for developing diabetes after GDM and GGI and inform culturally tailored, targeted, neighborhood and clinical perinatal interventions to lower future diabetes risk.
