BackgroundA growing body of evidence suggests that psychological stress is an independent cardiovascular risk factor. Obesity prevalence shows accelerating trends worldwide, and is known to be associated with a range of comorbidities and survival. The aim of this study was to assess the relationship between self-perceived psychological stress with parameters of adiposity, metabolic syndrome, and subclinical atherosclerosis in Mexican participants.MethodsMetabolic Syndrome was defined using the Adult Treatment Panel III criteria, obesity was defined as BMI >30, subclinical atherosclerosis disease was determined by computed tomography, and carotid intima media thickness was determined by ultrasonography. Self-perceived psychological stress was assessed using a single-item questionnaire.ResultsA total of 1243 control subjects were included in the sample, mean age 54.2 ± 9 years old; the prevalence of chronic self-perceived psychological stress (>5 years) was 10.13 %, female gender (62.7 %), obesity prevalence (48.4 %), and self-reporting sedentary lifestyle (56.3 %). The chronic stressed cohort presented higher subcutaneous abdominal fat content (285 vs 319 cm2), and carotid intima media thickness (0.63 vs 0.66 mm; p < 0.01 for both). However, after adjustment for lifestyle/social covariates (Model 1) and biological mediators (Model 2), chronic self-perceived stress was independently associated with obesity in men (OR 2.85, 95 % CI 1.51 – 5.40) and carotid atherosclerosis in women (OR 2.262, 95 % CI 1.47 – 4.67; p < 0.01 for both).ConclusionOur study suggests that self-reported chronic stress is an independent risk factor for obesity in men. In addition, carotid atherosclerosis was also found to be an independent risk factor in women in a Mexican population sample.

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IntroductionGestational diabetes mellitus (GDM) is underdiagnosed in Mexico. Early GDM risk stratification through prediction modeling is expected to improve preventative care. We developed a GDM risk assessment model that integrates both genetic and clinical variables.Research design and methodsData from pregnant Mexican women enrolled in the ‘Cuido mi Embarazo’ (CME) cohort were used for development (107 cases, 469 controls) and data from the ‘Mónica Pretelini Sáenz’ Maternal Perinatal Hospital (HMPMPS) cohort were used for external validation (32 cases, 199 controls). A 2-hour oral glucose tolerance test (OGTT) with 75 g glucose performed at 24–28 gestational weeks was used to diagnose GDM. A total of 114 single-nucleotide polymorphisms (SNPs) with reported predictive power were selected for evaluation. Blood samples collected during the OGTT were used for SNP analysis. The CME cohort was randomly divided into training (70% of the cohort) and testing datasets (30% of the cohort). The training dataset was divided into 10 groups, 9 to build the predictive model and 1 for validation. The model was further validated using the testing dataset and the HMPMPS cohort.ResultsNineteen attributes (14 SNPs and 5 clinical variables) were significantly associated with the outcome; 11 SNPs and 4 clinical variables were included in the GDM prediction regression model and applied to the training dataset. The algorithm was highly predictive, with an area under the curve (AUC) of 0.7507, 79% sensitivity, and 71% specificity and adequately powered to discriminate between cases and controls. On further validation, the training dataset and HMPMPS cohort had AUCs of 0.8256 and 0.8001, respectively.ConclusionsWe developed a predictive model using both genetic and clinical factors to identify Mexican women at risk of developing GDM. These findings may contribute to a greater understanding of metabolic functions that underlie elevated GDM risk and support personalized patient recommendations.

Women with Diabetes in Pregnancy (DP) have a higher risk of maternal-fetal complications, unfortunately in Mexico, its detection is only carried out in 1% of cases, and glucometers and glucose strips are not available for self-monitoring of blood glucose (SMBG). The cohort Cuido mi Embarazo (CME) ensures supplies for the Oral Glucose Tolerance Test (OGTT) and glucose screening through MIDO Embarazo®. Educational strategies have been implemented for health personnel focused on prevention, diagnosis and management. Patients with DP have been offered medical and nutritional counseling, and digital glucometers and glucose strips for SMBG. Up to now, 854 women are actively monitored and have performed the OGTT. 117 women have been found with diabetes, of which 96 (82.05%) are Gestational Diabetes (GDM) and 21 (17.95%) are pre-gestational diabetes, finding a prevalence of GDM of 11.2%. Regarding the SMBG in 84 women with diabetes that completed their pregnancy, 62 (73.8%) completed glucose measurements, representing a higher figure than the international literature. From those patients that completed their pregnancy with complete SMBG according to international standards, 39 (62.9%) women achieved control, 23 (37.1%) did not achieve control. No cases of children with macrosomia were detected. In the framework of the CME Cohort, it is demonstrated that: 1) Performing the OGTT and capillary glucose screening through MIDO Embarazo® allow the timely detection of DP. 2) Providing digital glucometers and glucose strips for SMBG, guarantees measurement, increases adherence and glucose control, and improves the health of the newborn and the mother. 3) The systematic approach that also includes the proactive participation of health professionals in the health center is a key element for success for the timely and adequate diagnosis of DP. These conclusions represent a significant public health lesson in Mexico. Disclosure L. Martinez-juarez: Research Support; Self; Lilly Global Health Partnership. R. Tapia-conyer: None. J. Lomelin-gascon: None. J. Ortega-montiel: Research Support; Self; Lilly Global Health Partnership. A. Benitez-herrera: None. D. Reyes-gómez: None. M. Carmona-ramos: None. L. Hernández-gonzález: None. E. Reyes-muñoz: Consultant; Self; Nestlé, Research Support; Self; Nestlé. H. Gallardo-rincón: None. Funding Eli Lilly and Company

GDM is a heterogeneous disease. Three subtypes of GDM have been identified, insulin sensitivity defect, insulin secretion defect, and both. Insulin sensitivity defect is associated with higher risk for fetal overgrowth and GDM associated adverse outcomes. Based on the 2hr-OGTT-75g values, the phenotype of GDM-sensitivity is associated with elevated fasting glucose and GDM-secretion by elevated one and/or two hours post-load glucose values. We evaluated the 2hr-OGTT-75g values of 1713 in Mexican pregnant women without previous diagnosis of T2D from the cohort study Cuido mi Embarazo between April 20 and December 2021. We identified 251 cases of GDM (14.6%) . Based on the distribution of 2hr-OGTT-75g values related to known GDM subtypes, 132 (52.6%) had elevated fasting glucose but normal post-load glucose values (GDM-sensitivity) , 90 (35.8%) had elevated post-load glucose but normal fasting glucose values (GDM-secretion) , and 29 (11.6%) patients with elevated fasting and post-load glucose values (GDM-mixed) . Women in the GDM-sensitivity group were younger (27.3 ± 6.5 yr) , nulliparous (56.1%) and more often had a family history of T2D (50.0%) compared to the women in the GDM-secretion and GDM-mixed groups. However, there was no statistical difference between the principal groups regarding pregestational BMI (GDM-sensitivity: 27.7 ± 5.5; GDM-secretion: 27.4 ± 4.4; GDM-mixed: 28.4 ± 6.2 kg/m2, p=0.90) ; although this last group showed the higher prevalence of obesity (29.4% - 23.3% - 38.0% respectively for each group) . To our knowledge, this is the first analysis of GDM subtypes in Mexican pregnant women. The high proportion of GDM diagnoses with normal fasting glucose supports the importance of unavoidably offering a complete OGTT. This strategic approach by classifying GDM subtypes according to OGTT values takes clinical importance in the offering of personalized and timely management care to minimize perinatal and newborn adverse outcomes. Disclosure H.Gallardo-rincón: None. N.Garcia-gonzalez: None. A.H.Perez-hernandez: None. B.Perez-romero: None. C.G.Granillo-ramirez: None. R.Tapia-conyer: None. J.Ortega-montiel: None. L.Martinez-juarez: None. J.Lomelin-gascon: None. A.Montoya: None. E.Reyes-muñoz: None. V.Galicia-hernandez: None. R.Avila-dominguez: None. L.V.Perez-torres: None. Funding Eli Lilly and Company