Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, The University of Chicago Pritzker School of Medicine, Chicago, IL.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University Health System, The University of Chicago Pritzker School of Medicine, Chicago, IL; Department of Psychology, Northwestern University, Evanston, IL.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100222. doi: 10.1016/j.ajogmf.2020.100222. Epub 2020 Sep 12.
Maternal psychosocial stress, including experiences of discrimination, has been linked to adverse pregnancy outcomes. Perceived discrimination may activate the chronic stress response, the downstream effects of which include dysregulation of metabolic and immune systems. The effect of perceived discrimination on the development of gestational diabetes mellitus, a metabolic disorder of pregnancy, has not been evaluated.
This study aimed to evaluate the association between perceived maternal discrimination and incidence of gestational diabetes mellitus.
A prospective cohort study of 744 pregnant women was conducted from 2013 to 2015 at 4 sites in the United States. Participants were women who were ≥18 years old with a singleton pregnancy, <21 weeks pregnant when recruited into the study, and English speaking without fetal anomalies, progesterone treatment, or corticosteroid use during pregnancy. Women with pregestational diabetes were excluded from the study. Participants with a gestational age between 12 0/7 and 20 6/7 weeks completed the Williams Discrimination Scale. For this analysis, Williams Discrimination Scale scores were dichotomized at the 75th percentile. We estimated the association between scoring in the top quartile of the Williams Discrimination Scale and developing gestational diabetes mellitus using logistic regression. As obesity is an independent risk factor for developing gestational diabetes mellitus, we also used mediation methods to determine the proportion of the association mediated by prepregnancy obesity (body mass index, ≥30 kg/m). Models were adjusted for maternal age, income, parity, race and ethnicity, and study site.
Among the 595 eligible subjects, 368 (61.9%) were white, 99 (16.6%) black, and 93 (15.6%) Hispanic. The mean body mass index was 27.4 kg/m (standard deviation, 7.1 kg/m), and 50 subjects (8.4%) developed gestational diabetes mellitus. Women with gestational diabetes mellitus were significantly more likely to be older, to be multiparous, and to have a lower income. Scoring in the top quartile of the Williams Discrimination Scale was associated with a significantly increased risk of developing gestational diabetes mellitus (12.8% vs 7.0%; adjusted odds ratio, 2.11; 95% confidence interval, 1.03-4.22). Obesity mediated 22.6% of the relationship between the Williams Discrimination Scale and gestational diabetes mellitus.
Women who perceived greater discrimination had an increased risk of developing gestational diabetes mellitus. Results from the mediation analysis indicate that more than 20% of the association between discrimination and gestational diabetes mellitus operates via a pathway that includes obesity. Future studies should examine this and other mechanistic pathways that may underlie these associations.
母体心理社会压力，包括歧视经历，与不良妊娠结局有关。感知到的歧视可能会激活慢性应激反应，其下游效应包括代谢和免疫系统的失调。感知到的歧视对妊娠糖尿病（一种妊娠代谢紊乱）的发展的影响尚未得到评估。
本研究旨在评估母体感知歧视与妊娠糖尿病发病率之间的关系。
这是一项前瞻性队列研究，于 2013 年至 2015 年在美国 4 个地点进行，研究对象为年龄≥18 岁、单胎妊娠、招募时妊娠<21 周、会说英语且无胎儿异常、孕激素治疗或妊娠期间使用皮质类固醇的孕妇。有孕前糖尿病的妇女被排除在研究之外。妊娠 12 0/7 至 20 6/7 周之间的孕妇完成了威廉姆斯歧视量表。在本分析中，威廉姆斯歧视量表评分在第 75 百分位处分为两部分。我们使用逻辑回归估计在威廉姆斯歧视量表的最高四分位评分与妊娠糖尿病的发展之间的关联。由于肥胖是妊娠糖尿病发病的独立危险因素，我们还使用中介方法来确定肥胖（体重指数，≥30kg/m）介导的关联比例。模型调整了母亲年龄、收入、产次、种族和民族以及研究地点。
在 595 名合格受试者中，368 名（61.9%）为白人，99 名（16.6%）为黑人，93 名（15.6%）为西班牙裔。平均体重指数为 27.4kg/m（标准差 7.1kg/m），50 名（8.4%）患有妊娠糖尿病。患有妊娠糖尿病的妇女年龄较大、多胎产、收入较低。在威廉姆斯歧视量表中得分最高的四分位数与发生妊娠糖尿病的风险显著增加相关（12.8%比 7.0%；调整后的优势比，2.11；95%置信区间，1.03-4.22）。肥胖介导了威廉姆斯歧视量表与妊娠糖尿病之间 22.6%的关系。
感知到更多歧视的女性患妊娠糖尿病的风险增加。中介分析的结果表明，歧视与妊娠糖尿病之间的关联有 20%以上是通过包括肥胖在内的途径运作的。未来的研究应该检查这一点和其他可能构成这些关联的机制途径。
