Interpersonal, Community/Environmental, and Societal Risk and Protective Factors for Gestational Diabetes and Hypertensive Disorders of Pregnancy Among Black Women in the United States: A Systematic Review
AI Summary
GDM and HDP disproportionately affect Black women; most studies examined societal-level risk factors using an adapted socioecological model.
Intimate partner violence was the only consistently significant interpersonal risk factor for both gestational diabetes and hypertensive disorders.
Protective factors remain underexamined; heterogeneity and study designs limit causality, but findings can inform improved risk assessment in clinical practice.
Matern Child Health J. 2026 May 18. doi: 10.1007/s10995-026-04268-x. Online ahead of print.
ABSTRACT
OBJECTIVES: Gestational diabetes (GDM) and hypertensive disorder of pregnancy (HDP) disproportionallyaffect the health of Black women during pregnancy and after birth. These conditions have mostly been examined separately and have largely focused on individual-level risk factors. We used an adapted socioecological model (SEM) to explore risk and protective factors for GDM and HDP among Black women beyond the individual level of influence.
METHODS: We searched MEDLINE, Embase, CINAHL Complete and Scopus databases for articles published through November 2023. Studies were included if they had samples of ≥ 50% Black women or stratified data by race and included measures of effect of interpersonal, community/environmental, or societal factors. We used PRISMA 2020 reporting guidelines and narratively synthesized the results by level of the SEM. We used QualSyst to assess the quality of included studies.
RESULTS: Nineteen studies met all our inclusion criteria; 10 examined societal factors making it the most examined socioecological level, six examined community/environmental factors, and three examined interpersonal level factors. Only three studies included outcomes of both GDM and HDP. Intimate partner violence was the only significant risk factor for both GDM and HDP.
CONCLUSION FOR PRACTICE: Although several risk factors were explored, protective factors have not been examined to the same extent and warrant further investigation. Findings from this review can be used to inform more comprehensive assessment tools for identifying patients at increased risk for adverse pregnancy outcomes. Limitations of our review include the inability to determine causality due to study designs and the inability to conduct a meta-analysis due to heterogeneity of findings.
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