In partnership with the NYC Department of Health and Mental Hygiene we have been studying how neighborhood environments influence health during pregnancy and birth outcomes, with recent work focusing on weight gain during pregnancy.   In 2009, the Institute of Medicine (IOM) issued revised recommendations for healthy gestational weight gain (GWG). However, despite the new guidelines, most pregnant individuals in the U.S. still do not gain the recommended amount of weight during pregnancy; almost 50% of pregnant individuals gain more weight than is recommended for a healthy pregnancy. Excessive GWG is associated with higher risk of pregnancy complications, including pregnancy-related hypertension and greater long-term postpartum weight retention. Excessive GWG is also associated with increased odds of child asthma, obesity, and greater percent body fat and abdominal adiposity.   

Using birth record data from all births in New York City in 2015 we found that higher neighborhood walkability was associated with lower risk of excessive gestational weight gain.  This protective effect was seen after controlling for the pregnant individual’s, age, race, place of birth, and education and the poverty rate in the residential neighborhood.  Further analyses that adjusted for pre-pregnancy body mass index suggest that the link between neighborhood walkability and lower risk of excessive gestational weight gain was due to differences in physical activity patterns, especially walking, during pregnancy.  This interpretation is consistent with past studies that find pregnant individuals favor lower intensity forms of exercise such as walking and that walking activity during mid-pregnancy is associated with lower risk of excessive gestational weight gain.  We have previously shown that higher neighborhood walkability is associated with more walking and more total physical activity.  The paper describing our research on gestational weight gain was published in the journal Obesity.

Multiple guidelines exist for planners and architects on how to design for health, including the NYC Active Design Guidelines, the WELL Community Standard, the American Institute of Architects Healthy Design Research Consortium, and the Department of Health and Human Service’s Healthy People 2020 guidelines. However, due to limited research on the implications of active design for health during pregnancy, few such guides consider pregnant individuals and their infants. Given the long-lasting benefits of healthy pregnancies for parental and child health, this research provides further impetus for the use of urban design to support healthy weight and reduce the risk of excessive gestational weight gain and associated health risks.