Neighborhood Typology and Cardiometabolic Pregnancy Outcomes in the Maternal Adiposity Metabolism and Stress (MAMAS) Study

OBJECTIVE: To assess associations between neighborhood typologies classified across multiple neighborhood domains and cardiometabolic pregnancy outcomes and determine variation in effectiveness of a mindfulness-based stress reduction intervention on outcomes across neighborhood types. METHODS: We classified neighborhoods of participants in the Maternal Adiposity Metabolism and Stress (MAMAS) intervention (n=208) across dimensions of socioeconomic, food, safety and service/resource environments using latent class analysis. We estimated associations between neighborhood type and three cardiometabolic pregnancy outcomes— glucose tolerance (GT) during pregnancy, excessive gestational weight gain, and 6-month postpartum weight retention (PPWR)—using marginal regression models. We assessed interaction between neighborhood type and intervention. RESULTS: We identified five neighborhood types differing across socioeconomic, food, and resource environments. Compared to poor, well-resourced neighborhoods, middle income neighborhoods with low resources had higher risk of impaired GT (Relative Risk (RR): 4.1; 95% Confidence Interval (CI): 1.1, 15.5); and wealthy, well-resourced neighborhoods had higher PPWR (Beta: 3.9 kg; 95% CI: 0.3, 7.5). Intervention effectiveness varied across neighborhood type with wealthy, well-resourced and poor, moderately-resourced neighborhoods showing improvements in GT scores. PPWR was higher in intervention compared to control groups within wealthy, well-resourced neighborhoods. CONCLUSION: Consideration of multidimensional neighborhood typologies revealed important nuances in intervention effectiveness on cardiometabolic pregnancy outcomes.