Simmons University School of Social Work, Boston, Massachusetts.
Simmons University School of Social Work, Boston, Massachusetts.
Womens Health Issues. 2023 Nov-Dec;33(6):600-609. doi: 10.1016/j.whi.2023.06.007. Epub 2023 Aug 3.
Racial/ethnic and nativity disparities in gestational diabetes mellitus (GDM) persist in the United States. Identified factors associated with these differences do not fully explain them. Research has recognized psychosocial stress as a potentially modifiable risk factor for GDM.
We used New York City Pregnancy Risk and Assessment Monitoring System data (2009-2014) linked with birth certificate items (n = 7,632) in bivariate and multivariate analyses to examine associations between 12 psychosocial stressors (modeled three ways: individual stressors, grouped stressors, stress constructs) and GDM across race/ethnicity and nativity, and if stressors explain racial/ethnic/nativity differences in GDM.
U.S. and foreign-born Black and Hispanic women reported higher stressors relative to U.S.-born White women. In fully adjusted models, the financial stress construct was associated with a 51% increased adjusted risk of GDM, and adding all stressors doubled the risk. Psychosocial stressors did not explain the elevated risk of GDM among foreign-born Black (adjusted risk ratio, 2.18; 95% confidence interval, 1.53-3.11), Hispanic (adjusted risk ratio, 1.57; 95% confidence interval, 1.10-2.25), or Asian/Pacific Islander (adjusted risk ratio, 4.10; 95% confidence interval, 3.04-5.52) women compared with U.S.-born White women.
Historically minoritized racial/ethnic and immigrant women have an increased risk of psychosocial stressors and GDM relative to U.S.-born White women. Although financial and all stressors predicted higher risk of GDM, they did not explain the increased risk of GDM among immigrant women and women from minoritized racial/ethnic groups. Further examination into racial/ethnic and nativity inequalities in stress exposure and rates of GDM is warranted to promote healthier pregnancies and birth outcomes.
在美国，妊娠糖尿病（GDM）在种族/民族和出生地方面存在差异。与这些差异相关的已确定因素并不能完全解释这些差异。研究已经认识到心理社会压力是 GDM 的一个潜在可改变的危险因素。
我们使用了纽约市妊娠风险和评估监测系统的数据（2009-2014 年），并与出生证明项目（n=7632）进行了二元和多元分析，以检查 12 种心理社会应激源（以三种方式建模：个体应激源、分组应激源、应激结构）与跨种族/民族的 GDM 之间的关系，以及应激源是否解释 GDM 中的种族/民族/出生地差异。
与美国出生的白人女性相比，美国和外国出生的黑人和西班牙裔女性报告的应激源更高。在完全调整的模型中，经济压力结构与 GDM 调整后风险增加 51%相关，而增加所有应激源则使风险增加一倍。心理社会应激源并不能解释外国出生的黑人（调整后的风险比，2.18；95%置信区间，1.53-3.11）、西班牙裔（调整后的风险比，1.57；95%置信区间，1.10-2.25）或亚裔/太平洋岛民（调整后的风险比，4.10；95%置信区间，3.04-5.52）女性患 GDM 的风险升高。
历史上处于少数群体的种族/民族和移民女性与美国出生的白人女性相比，面临更高的心理社会应激源和 GDM 的风险。尽管经济和所有应激源都预示着 GDM 的风险更高，但它们并不能解释移民女性和少数族裔群体女性中 GDM 风险的增加。进一步研究压力暴露和 GDM 发生率方面的种族/民族和出生地不平等现象是有必要的，以促进更健康的妊娠和分娩结果。
