Gestational diabetes mellitus (GDM) is defined as glucose intolerance arising or first recognized during pregnancy. It is a growing public health crisis, with rates increasing across all maternal age groups. In NYC, women with GDM experience a more than 11 times higher risk of developing Type 2 Diabetes (T2DM) compared to those without GDM over 12 years, though this risk may be substantially higher among Black, Hispanic and South/Southeast Asian women.1 Given GDM’s impact on life course health, pregnancy is an important window for intervention specially for racially and ethnically diverse, immigrant and low-income populations who bear a disproportionate burden on both GDM
and subsequent T2DM.

The A1c in Pregnancy and Postpartum Linkage for Equity (APPLE) Cohort is a cohort that uses a novel linkage of SPARCS
hospital discharge records, NYC birth records, HbA1c Registry data, and neighborhood-level social and built environment features. This makes it a unique dataset that tracks metabolic health trajectories among women
with GDM: HbA1c >6.5% during pregnancy and the postpartum period. The R01-funded study also includes
a qualitative component, which involves in-depth, semi-structured interviews with racially and ethnically diverse
populations who have experienced a GDM pregnancy. By documenting their experiences across pregnancy, postpartum care, and diabetes management, the APPLE Cohort identifies opportunities to improve care pathways. The APPLE Cohort is guided by a conceptual framework in which structural racism, economic and gender inequality, and multi-level policies shape neighborhood and individual-level conditions including social and built environment features that drive the pathway from GDM to T2DM.