Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits

Objective: To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. Design: Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. Setting: Philadelphia, Pennsylvania, United States. Participants: Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). Methods: We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. Results: We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women's glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). Conclusion: It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.