Exploring physical activity and mental health during pregnancy in women with diabetes.

怀孕是一个关键的人生转变，在这个过程中，妇女的心理健康和幸福与她们自己和孩子的身体健康有着内在的联系。与许多人生转变一样，怀孕与重大变化、复杂的决定和增加的压力有关，这些都会影响应对能力。孕妇所经历的这种脆弱性和巨大的心理负担在慢性健康状况的存在下加剧。糖尿病(既往存在的1型或2型糖尿病，或紧急妊娠期糖尿病)是怀孕期间影响妇女的最常见的慢性疾病。在2021年，糖尿病影响了超过10%的英国有记录的怀孕，导致了活产(约65000)。然而，尽管很难准确量化，但总体影响要大得多，因为流产、先天性畸形和许多不利的孕产妇和新生儿结果的风险增加了3-4倍。孕期管理糖尿病对产妇焦虑和心理健康有着深远的影响，因为怀孕并发症的风险增加，必须更严格地控制血糖水平以降低这些风险的挑战，以及治疗变化的影响。1、8-10鉴于其流行率和后果，妊娠期糖尿病是心理健康不平等的重要驱动因素，世卫组织、ESRC和MRC确定了优先行动领域。因此，了解减轻妊娠期糖尿病精神健康负担的策略是当务之急。妊娠期有规律的体力活动(PA)可以改善心血管健康，降低许多不良妊娠和分娩结局的风险，并改善情绪和心理健康。因此，2019年，英国首席医疗官发布了首个针对孕妇的PA指南，建议每周适度PA 150分钟。14在怀孕期间，无并发症怀孕的女性PA水平下降：在怀孕3个月时，只有10%的人会达到推荐的活动水平。对于患有糖尿病的女性，达到这个水平尤其困难。有限的证据表明，大多数人都非常不活跃。卫生保健专业人员(初级保健人员：助产士、医生、健康访客、社区护士)在支持怀孕期间患有糖尿病的妇女方面发挥着关键作用。英国《孕产审查》设想在怀孕期间根据个人情况提供有效的支持。然而，由于我们知识上的根本差距，目前还没有循证指南来支持妊娠期糖尿病女性患者的PA。目前还没有人研究：1：怀孕期间PA模式是如何随着时间的推移而变化的，以及这些变化在不同糖尿病诊断和不同背景的女性中可能有何不同。妊娠期间PA的纵向变化可能与糖尿病、情绪和心理健康结果的管理变化有关。2：妊娠期糖尿病妇女的生活经历、PA的心理决定因素和对其改善精神健康和福祉的潜力的看法之间的相互作用，以及他们对哪些信息和支持可能最有用的看法。3：HCP和其他利益攸关方在支持妊娠期糖尿病妇女方面的经验，他们对PA作为潜在治疗工具的看法，以及可能最有用的资源/战略/材料。这一跨学科的博士项目将结合证据合成、流行病学和心理学研究方法，以解决上述基本知识差距，并为改善对妊娠期糖尿病妇女的心理健康提供支持。这将通过合并现有文献和一项新颖而雄心勃勃的混合方法纵向研究来实现

Pregnancy is a key life transition in which women's mental health and wellbeing are intrinsically linked to their own physical health and that of their baby. Like many life transitions, pregnancy is associated with significant change, complex decisions and increased stress which can impact coping abilities. This vulnerability and substantial psychological burden experienced by expectant mothers is exacerbated in the presence of chronic health conditions. Diabetes (pre-existing type 1 or type 2, or emergent gestational diabetes) is the most common chronic condition affecting women during pregnancy. In 2021 diabetes affected over 10% of recorded UK.pregnancies resulting in live births (~65000). However, the overall impact, although difficult to quantify precisely, is substantially greater due to the 3-4 fold increase in risk of miscarriage, congenital malformations and numerous adverse maternal and neonatal outcomes.Managing diabetes during pregnancy has a profound impact on maternal anxiety and mental health due to heightened risk of pregnancy complications, the challenges of having to control glucose levels even more tightly to mitigate these risks, and the impact of changes to treatment.1,8-10 Given its prevalence and consequences, diabetes in pregnancy is an important driver of mental health inequality, a priority area for action identified by the WHO, ESRC and MRC. Understanding strategies to reduce the mental health burden of diabetes in pregnancy therefore is a priority.Regular physical activity (PA) during pregnancy improves cardiovascular health, reduces risk of numerous adverse pregnancy and labor outcomes and improves mood and mental health. As such in 2019 the UK Chief Medical Officers published the first PA guidelines for pregnant women, recommending 150 mins of moderate PA per week.14 During pregnancy PA levels decline among women with uncomplicated pregnancy: as few as 10% will be reach recommended activity levels in trimester 3. For women with diabetes, reaching this level of PA is especially difficult. Limited evidence suggests most are very inactive.Healthcare professionals (HCPs: midwives, doctors, health visitors, community nurses) are key in supporting women with diabetes during pregnancy. The UK Maternity Review envisions effective support during pregnancy based on individual circumstances. However, at present there is no evidence-based guidance to support PA in women with diabetes during pregnancy due to fundamental gaps in our knowledge. At present no one has examined: 1: How PA patterns change over time during pregnancy, and how these changes may be different in women with different diabetes diagnoses and from different backgrounds. Longitudinal changes in PA during pregnancy may be linked to changes in management of diabetes, mood and mental health outcomes. 2: The interaction between lived experiences of women with diabetes during pregnancy, the psychological determinants of PA and perceptions of its potential to improve mental health and wellbeing, and their views regarding what information and support might be most useful.3: The experiences of HCPs and other stakeholders of supporting women with diabetes during pregnancy, their perceptions of both PA as a potential therapeutic tool and the resources/strategies/materials which could be most useful. This interdisciplinary PhD project will combine evidence synthesis, epidemiological and psychological research methods to address fundamental knowledge gaps outlined above, and to inform improved support for the mental health of women with diabetes during pregnancy. This will be achieved through consolidation of existing literature and a novel and ambitious mixed-methods longitudinal study