Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.
Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Diabetes Res Care. 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-000938.
Higher neighborhood walkability has been associated with a lower risk of type 2 diabetes mellitus (T2DM) by promoting greater physical activity (thereby reducing weight and lowering insulin resistance). However, it is not known if walkability may similarly reduce maternal risk of gestational diabetes mellitus (GDM), which arises in the setting of the severe physiologic insulin resistance of pregnancy. Indeed, the insulin resistance of pregnancy is primarily driven by placental hormones and not maternal weight gain. Thus, we sought to evaluate the impact of neighborhood walkability on maternal risk of GDM and the pathophysiologic determinants thereof (insulin sensitivity and pancreatic beta-cell function).
In this study, 1318 women reported their pregravid physical activity (Baecke questionnaire) while undergoing an oral glucose tolerance test (OGTT) at mean 29.3 weeks' gestation. The OGTT identified 290 women with GDM and enabled assessment of insulin sensitivity and beta-cell function. Based on their residential Walk Score, the women were stratified into the following four established categories of neighborhood walkability: car dependent (n=328), somewhat walkable (n=315), very walkable (n=406), and walker's paradise (n=269).
There was a progressive increase in pregravid total physical activity (p=0.002), non-sport leisure-time activity (p=0.009) and sport activity (p=0.01) across the walkability groups (from car dependent to somewhat walkable to very walkable to walker's paradise), coupled with a concomitant decline in pre-pregnancy body mass index (p=0.007). However, in pregnancy, the groups did not differ in gestational weight gain (p=0.80). Moreover, the walkability groups also did not differ in mean adjusted insulin sensitivity, beta-cell function, or glycemia on the antepartum OGTT. On logistic regression analysis, Walk Score did not predict GDM (OR=1.001, 95% CI 0.995 to 1.007).
Neighborhood walkability is not a significant determinant of maternal risk of GDM. Thus, in contrast to T2DM, the effect of neighborhood design on incidence of GDM will be comparatively modest.
较高的邻里步行性通过促进更多的身体活动（从而减轻体重和降低胰岛素抵抗），与 2 型糖尿病（T2DM）风险降低相关。然而，步行性是否同样可以降低妊娠糖尿病（GDM）的产妇风险尚不清楚，后者出现在妊娠严重的生理性胰岛素抵抗的情况下。实际上，妊娠的胰岛素抵抗主要是由胎盘激素驱动的，而不是由产妇体重增加引起的。因此，我们试图评估邻里步行性对 GDM 产妇风险及其病理生理决定因素（胰岛素敏感性和胰岛β细胞功能）的影响。
在这项研究中，1318 名女性在妊娠 29.3 周时进行口服葡萄糖耐量试验（OGTT）时报告了她们的孕前体力活动（Baecke 问卷）。OGTT 确定了 290 名患有 GDM 的女性，并能够评估胰岛素敏感性和胰岛β细胞功能。根据她们的居住步行得分，女性被分为以下四个既定的邻里步行性类别：依赖汽车（n=328）、有点步行性（n=315）、非常步行性（n=406）和步行者天堂（n=269）。
在步行性组中，孕前总体力活动（p=0.002）、非运动休闲时间活动（p=0.009）和运动活动（p=0.01）呈逐渐增加趋势，同时伴随孕前体重指数（p=0.007）的相应下降。然而，在怀孕期间，各组的妊娠体重增加没有差异（p=0.80）。此外，在产前 OGTT 上，步行性组之间的平均调整后胰岛素敏感性、胰岛β细胞功能或血糖也没有差异。在逻辑回归分析中，步行得分不能预测 GDM（OR=1.001，95%置信区间 0.995 至 1.007）。
邻里步行性不是 GDM 产妇风险的重要决定因素。因此，与 T2DM 不同，邻里设计对 GDM 发病率的影响将相对较小。
