Abstract
Objective
Our study examines the association between social vulnerability index (SVI) and pharmacotherapy
initiation for gestational diabetes mellitus (GDM).
Methods
We studied a retrospective cohort of pregnant patients with GDM, enrolled in Tennessee
Medicaid, who gave birth between 2007 and 2019. Enrollment files were linked to birth
and death certificates, state hospitalization registries, and pharmacy claims. SVI,
measured at the community level and determined by residential census tract, ranged
from 0 to 100 (low to high vulnerability). Multivariable logistic regression assessed
the association between SVI and the odds of initiating the most common pharmacotherapies
for GDM—insulin, glyburide, or metformin—and adjusted for relevant covariates. SVI
was modeled with restricted cubic splines to account for nonlinear associations, using
the median Tennessee SVI as a reference. Secondary analysis assessed associations
with the SVI subthemes.
Results
Among 33,291 patients with GDM, 21.7% (7,209) initiated pharmacotherapy during pregnancy.
Patients from areas with higher SVI were more likely to be non-Hispanic Black with
higher body mass index, whereas those with lower SVI were more likely to be nulliparous.
Multivariable modeling demonstrated a complex nonlinear association between SVI and
GDM pharmacotherapy initiation, relative to the reference. Higher SVI was associated
with elevated odds of GDM pharmacotherapy initiation (e.g., odds ratio 1.11 [95% confidence
interval 1.02–1.22] for SVI 80) and low to medium SVI had variable nonsignificant
associations with GDM pharmacotherapy initiation, relative to the reference (lower
odds of initiation for values 25–50, higher odds of initiation for values < 25). Secondary
analysis demonstrated a nonlinear association between subtheme 3 and the odds of GDM
pharmacotherapy initiation.
Conclusion
Social vulnerability is associated with initiation of pharmacotherapy for GDM, highlighting
the possible role of social determinants of health in achieving glycemic control.
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Biography
Amelie Pham, MD, is a Clinical Fellow in the Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Andrew Weise, PhD, MPH, is an Assistant Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Andrew Spieker, PhD, is an Assistant Professor in the Department of Biostatistics, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Sharon Phillips, MSPH, is an Associate in the Department of Biostatistics, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Margaret Adgent, PhD, MSPH, is an Assistant Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Carlos Grijalva, MD, MPH, is an Associate Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Biography
Sarah Osmundson, MD, MS, is an Associate Professor in the Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.
Article info
Publication history
Published online: January 19, 2023
Accepted:
December 22,
2022
Received in revised form:
December 20,
2022
Received:
June 3,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding Statement: This work was supported by the National Institutes of Health (grant number: R21HD104983; grant number: 5K12HD043483) and the National Institute on Drug Abuse (grant number: K01DA051683; grant number: K23DA047476). The funders did not have a role in any aspect of developing the report or in the decision to submit the article for publication. C.G.G. reports consulting fees from Pfizer, Sanofi, and Merck, and received research support from Sanofi-Pasteur, the Campbell Alliance/Syneos Health, NIH, CDC, FDA and AHRQ. A.D.W. reports consulting fees from the Tennessee Department of Health. All other authors report no conflict of interest.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
