Food, Built and Socio-Economic Environments and Maternal-Infant Outcomes: A Geospatial and Structural Equation Modelling of 163 000 Births.

OBJECTIVES

To examine the combined influence of food environment, built environment, socio-economic status and individual factors (maternal age, parity, smoking status and need for an interpreter) on maternal overweight, gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) births in Australia.

DESIGN

Retrospective cohort study.

SETTING

Melbourne, Australia.

POPULATION: 163 760 singleton pregnancies/births.

MAIN OUTCOMES MEASURES: Primary outcomes: maternal overweight, GDM and LGA births.

METHODS

Structural equation modelling (SEM) assessed direct and indirect associations, with maternal overweight as a mediator. LCA was used to classify risk variation across socio-economic strata.

RESULTS

Among 163 760 births, a higher density of unhealthy food outlets, lower liveability scores and greater socio-economic disadvantage were associated with maternal overweight. Maternal overweight strongly predicted GDM (c = 0.118, 95% CI: 0.113-0.124; p < 0.001) LGA births (c = 0.058, 95% CI: 0.053-0.059; p < 0.001), while higher liveability and walkability environments were protective against maternal overweight (c = -0.011, 95% CI: -0.019 to -0.002; p < 0.05). LCA identified a high-risk subgroup (85.1% overweight, 34.4% GDM) concentrated in socio-economically disadvantaged areas with poor access to healthy food and more walkable neighbourhoods.

CONCLUSIONS

Environmental and socio-economic factors have significant independent influences on maternal overweight, GDM and LGA births. Addressing food access disparities, improving the walkability and liveability of residential areas and ensuring equitable healthcare infrastructure could reduce maternal health risks and promote better pregnancy outcomes.