Silveira M L, Whitcomb B W, Pekow P, Braun B, Markenson G, Dole N, Manson J E, Solomon C G, Carbone E T, Chasan-Taber L
Division of Biostatistics & Epidemiology, Department of Public Health, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA.
Department of Kinesiology, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA, USA.
Diabetes Metab. 2014 Dec;40(6):466-75. doi: 10.1016/j.diabet.2014.05.002. Epub 2014 Jun 16.
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).
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.
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 5.5mg/dL increase in screening glucose level (β=5.5; standard deviation=2.8; P=0.05), after adjusting for the same variables.
In this population of predominantly Puerto Rican women, stress patterns during pregnancy may influence the risk of glucose intolerance.
既往文献表明，社会心理压力与非妊娠人群患糖尿病的风险呈正相关，但孕期相关研究较少。在马萨诸塞州西部的一项前瞻性队列研究“健康计划项目”（2006 - 2011年）中，我们评估了1115名西班牙裔（主要是波多黎各裔）产前护理患者的压力与糖耐量异常之间的关系。
在孕早期（平均孕周 = 12.3周；范围4.1 - 18周）和孕中期（平均孕周 = 21.3周；范围18.1 - 26周）使用科恩感知压力量表（PSS - 14）进行评估。根据妊娠24至28周期间糖耐量测试的异常程度，将参与者分为患有妊娠期糖尿病、糖耐量受损和糖耐量异常的妊娠患者。
妊娠期糖尿病、糖耐量受损和糖耐量异常的患病率分别为4.1%、7.2%和14.5%。孕早期或孕中期的绝对压力水平与糖耐量异常无显著关联。然而，在调整年龄和孕前体重指数后，与压力无变化或降低的参与者相比，孕早期至孕中期压力增加的参与者患妊娠期糖尿病的几率增加了2.6倍（95%置信区间：1.0 - 6.9）。此外，在调整相同变量后，压力评分每增加1分，筛查血糖水平升高5.5mg/dL（β = 5.5；标准差 = 2.8；P = 0.05）。
在这个主要为波多黎各裔女性的人群中，孕期的压力模式可能会影响糖耐量异常的风险。
