Perceived psychosocial stress and glucose intolerance among pregnant Hispanic women

Abstract

Aim Prior literature suggests a positive association between psychosocial stress and the risk of diabetes in non-pregnant populations, but studies during pregnancy are sparse. We evaluated the relationship between stress and glucose intolerance among 1115 Hispanic (predominantly Puerto Rican) prenatal care patients in Proyecto Buena Salud, a prospective cohort study in Western Massachusetts (2006–2011). Methods Cohen’s Perceived Stress Scale (PSS-14) was administered in early (mean = 12.3 weeks gestation; range 4.1–18 weeks) and mid-(mean = 21.3 weeks gestation; range 18.1–26 weeks) pregnancy. Participants were classified as having a pregnancy complicated by gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance, based on the degree of abnormality on glucose tolerance testing between 24 and 28 weeks of gestation. Results The prevalence of gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance was 4.1%, 7.2%, and 14.5%, respectively. Absolute levels of early or mid-pregnancy stress were not significantly associated with glucose intolerance. However, participants with an increase in stress from early to mid-pregnancy had a 2.6-fold increased odds of gestational diabetes mellitus (95% confidence intervals: 1.0–6.9) as compared to those with no change or a decrease in stress after adjusting for age and pre-pregnancy body mass index. In addition, every one-point increase in stress scores was associated with a 5.5 mg/dL increase in screening glucose level (β = 5.5; standard deviation = 2.8; P = 0.05), after adjusting for the same variables. Conclusion In this population of predominantly Puerto Rican women, stress patterns during pregnancy may influence the risk of glucose intolerance.

Perceived psychosocial stress and gestational weight gain among women with gestational diabetes

“…A previous study by Silveira et al reported that an increase in stress level between early to mid-pregnancy substantially increased the odds of developing GDM among Hispanic women, compared to those with no change or a reduction in stress. [35] Although we were unable to assess the temporal relationship between stress during the early stage of pregnancy and the risk of developing GDM or excess/inadequate GWG, our study extended previous findings by suggesting that there may be associations between stress around the time of GDM diagnosis and increased risk of excess or inadequate total GWG. Second, although we did not observe mediating role of diet and physical activity, it is possible that the measures were not accurate, resulting in lack of observation.…”

Relationship between depression and diabetes in pregnancy: A systematic review

“…Overall, 48 publications were included in this review (Figure 1, Table 1, Table 2, Table 3, Supplementary Table 1). Of these, 30 described prospective observational studies[20,21,23,24,26,27,29-31,34,35,37,38,41,43-45,47-49,51,54,57,58,60-62,65-67], 15 described retrospective observational studies[22,25,28,32,39,40,42,46,50,53,55,56,59,63,64], and three described randomized controlled trials (RCTs)[33,36,52], two of which reported only baseline data[36,52]. Two publications described the same study, but reported different subgroup analyses[23,29].…”

“…A total of 28 studies included only women with GDM[20,23,26-29,31,33,35-38,40,43-45,47-49,51-53,57,58,60,61,63,64], 14 included women with either GDM or pre-existing diabetes (although the type was not always reported)[22,25,39,41,42,46,50,54-56,59,62,65,66], one included women with either GDM or type 1 diabetes[34], one included only women with type 1 diabetes[67], one included only women with pre-existing diabetes (type not reported)[30] and three did not report the type of diabetes[21,24,32] (Tables 1-3, Supplementary Table 1). Sample sizes ranged from 36[65] to more than 32 million in a retrospective analysis of a nationwide hospital database[22] (Tables 1-3, Supplementary Table 1).…”

“…Among women with GDM (Table 1, Figure 3), the reported prevalence of depression during or after pregnancy ranged widely, from 4.1% to 80% (16 studies[26,31,33,35,39-41,43,44,46,51,52,54,57,58,61], median 14.7%). Heterogeneity in sample size, the definition of depression, and the timing of its assessment is likely to have contributed to this wide range of prevalence rates.…”

“…In one study[35], the prevalence of depression among women with GDM was significantly greater than pregnant women without diabetes at 30 wk gestation, but not at 36 wk gestation or postpartum. In contrast, 16 studies reported no significant effect of GDM on the prevalence or risk of depression[23,27,31,34,38,41-44,47,49,57,58,62,63,66]. …”