August 26, 2026 -- More walkable neighborhoods in New York City were associated with a lower risk of developing postpartum type 2 diabetes among women who had gestational diabetes mellitus (GDM), according to a new study from Columbia University Mailman School of Public Health. However, the association varied depending on individual and neighborhood socioeconomic circumstances, including Medicaid coverage and neighborhood economic deprivation. The findings are published in the journal Diabetes Care.
While earlier research had found that neighborhood walkability is associated with a lower risk of GDM, until now the association of postpartum type 2 diabetes after GDM was unknown. The new study provides evidence that neighborhood environments may play a role in diabetes risk after pregnancy.
“Women with GDM are at high risk of developing type 2 diabetes,” said Bohao Wu, PhD, postdoctoral graduate in Epidemiology at Columbia Mailman School, and first author. “But less is known about how individual and neighborhood factors jointly influence the development of type 2 diabetes after GDM. Our study helps fill this gap by examining the relationship between neighborhood walkability and diabetes risk over 12 years.”
Although GDM typically resolves after delivery, it can be a strong predictor of future type 2 diabetes. The researchers noted that their findings are consistent with evidence from large population-based and ecological studies conducted in Canada, Sweden and Australia, which have also linked characteristics of the built environment with diabetes-related outcomes.
The researchers leveraged the A1C in Pregnancy and Postpartum Linkage for Equity (APPLE) study, a population-based retrospective cohort of women who gave birth in New York City between 2009 and 2011.
Women with GDM were identified through birth certificate records and hospital discharge data and linked to laboratory records of A1C results from the New York City Department of Health and Mental Hygiene.
The researchers followed women through 2021 and identified the development of type 2 diabetes based on A1C results of 6.5 or higher occurring at least 12 weeks postpartum. Women with pre-pregnancy diabetes were excluded.
Among the final cohort of 12,403 women with GDM, the 12-year cumulative incidence of type 2 diabetes was 21 percent
The researchers also used statistical modeling to examine the association between neighborhood walkability and development of type 2 diabetes after GDM, controlling for individual- and neighborhood-level characteristics, including age, race and ethnicity, educational attainment, nativity, parity and neighborhood economic deprivation.
After adjustment for these factors, women living in neighborhoods with medium levels of walkability had a 15 percent lower rate of developing type 2 diabetes after GDM compared with women living in less-walkable neighborhoods.
However, the association between high neighborhood walkability and lower diabetes risk was observed only among women living in the most affluent neighborhoods. “The findings suggest that neighborhood walkability cannot be considered independently from the broader social and economic conditions in which people live,” noted Wu.
“While increasing walkability is a core planning goal and may improve cardiometabolic health, policies should also address neighborhood economic disadvantage for maximum impact,” said senior author Teresa Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School and principal investigator. “Our findings suggest that the potential benefits of walkable environments may be diminished in economically disadvantaged settings, where structural and social barriers associated with poverty could offset some of the health-promoting effects of the built environment.”
In economically deprived neighborhoods, walkable environments may also coincide with greater exposure to pollution and heavy traffic, limited green space, safety concerns, or reduced access to health-promoting resources, according to Janevic.
“Our study adds new longitudinal evidence suggesting that higher-walkability neighborhoods may benefit women with GDM,” said Wu. “At the same time, our findings show that neighborhood context is more complex than physical design alone. Built-environment characteristics should be considered alongside broader neighborhood conditions, including economic deprivation, social cohesion as well as access to health-promoting assets.”
Understanding these contextual factors has implications for both population-level health interventions and urban planning. Efforts to create more walkable communities may have greater health benefits when paired with strategies that address the social and economic conditions that shape residents’ ability to benefit from the built environment, noted Janevic.
Other co-authors are Natalie A. Boychuk, Frances M. Howell, Sandra S. Albrecht, and Andrew G. Rundle, Columbia Mailman School; Shelley H. Liu, Icahn School of Medicine at Mount Sinai; Hiu Tai Chan, Kacie Seil, and Bahman Tabaei, New York City Department of Health.
This study was funded by National Institutes of Health grant R01DK134725.
No potential conflicts of interest were reported.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting NewYorkers, the nation and the world. The Columbia Mailman School is the third largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu .
Diabetes Care
Neighborhood Walkability and the Development of Type 2 Diabetes After Gestational Diabetes Mellitus: A Longitudinal Study in New York City Available
11-Aug-2026