Neighborhood food environments and size for gestational age


In a recent study, pregnant individuals residing in neighborhoods with greater densities of unhealthy food were at an increased risk of giving birth to infants who were small for gestational age or large for gestational age.

Neighborhood food environments and size for gestational age | Image Credit: © Konstantin L - © Konstantin L -

Neighborhood food environments and size for gestational age | Image Credit: © Konstantin L - © Konstantin L -

According to a recent study published in JAMA Network Open, small for gestational age (SGA) and large for gestational age (LGA) risks are associated with healthfulness of neighborhood food environments.

SGA is defined as having a birth weight under the 10th percentile for gestational age (GA) at birth and sex, while LGA is defined as having a birth weight over the 90th percentile for GA at birth and sex. Both conditions have been associated with increased health complication risks, such as obesity, high blood pressure, and heart disease.

Data has indicated an association between neighborhood socioeconomic status conditions and SGA risk, but this data remains limited. To determine how excessive gestational weight gain (GWG) impacts the association between unhealthy food environments and birth weight outcomes, investigators conducted a cross-sectional study.

The 2015 vital statistics records from the New York City (NYC) Department of Health and Mental Hygiene were consulted for data on births in NYC. Eligibility criteria included being singleton births, having a plausible prepregnancy body mass index (BMI) or childbirth weight, and having a GA of 22 to 42 weeks.

Births with missing maternal height or weight data, along with those missing exposure or outcome variables, were excluded from the analysis. Neighborhood variables were obtained by matching pregnant individuals to 2010 census blocks. These variables were then categorized into quartiles, with neighborhood-level variable distribution used to determine quartile cut points.

The 2014 National Establishment Time Series data set was consulted to determine walkable destination and retail food establishment locations. A team of investigators categorized locations as healthy or unhealthy using methods of a previous study involving measuring if the food available supported a healthy weight.

The density of walkable destinations was also measured using data from the National Establishment Time Series. Residential density, land use mix, street intersection density, subway stop density, and the retail building floor area to retail land area ratio were used to measure the 2015 neighborhood walkability index.

GA was measured in weeks and birth weight in grams. Covariates included prepregnancy BMI, education level, age, nativity, parity, smoking status before pregnancy, and race and ethnicity.

There were 106,194 births included in the final analysis, with pregnant individuals aged a mean 29.9 years. Of pregnant individuals, 59.1% were married and 44.4% were nulliparous. Of births, 12.9% were SGA and 8.4% LGA, with a mean birth weight for GA z score of -0.14. Higher GWG z scores indicated reduced risks of SGA.

Higher rates of pregnancy were seen in individuals from locations with increased poverty rates, food density, and walkability. The first quartile for unhealthy food density and walkability contained 7.2% and 9.9% of pregnant individuals respectively, compared to 48.2% and 38.7% respectively for the highest unhealthy quartiles.

Reduced SGA risks were observed in quartiles with higher densities of healthy food, while SGA risks were increased in neighborhoods with increased densities of unhealthy food. Models also indicated a positive association between LGA risk and quartile density of unhealthy food retail locations, with GWG indicated as a mediating variable.

Overall, an association was observed between the healthfulness of neighborhood food environments and SGA and LGA, providing further evidence on the impact of neighborhood environment features on pregnancy and birth outcomes. Investigators recommended cost-benefit analyses include components for supporting the health of young children.


Kinsey EW, Widen EM, Quinn JW, et al. Neighborhood food environment and birth weight outcomes in New York City. JAMA Netw Open. 2023;6(6):e2317952. doi:10.1001/jamanetworkopen.2023.17952

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