Epidemiology of Stress and GDM among Latina Women

糖尿病和肥胖症在美国已经达到流行的程度，拉丁裔的发病率一直较高 而不是非拉丁裔白人。将这些疾病的预防期限上游转移到怀孕，可能是一种 创新战略。这项提案的主要目的是评估新的和及时的关于 拉丁裔妇女妊娠期糖尿病的可改变决定因素。我们建议评估外部因素和外部因素之间的关联 应激源(身体活动)、内部应激源(心理社会应激)以及这些变量和 妊娠期糖尿病的风险。 采用前瞻性队列设计，2300名拉丁裔(主要是波多黎各人)产前护理患者将 在他们第一次产前检查(怀孕8-12周)时从贝斯托医学中心招募。双语 面试官将通过孕期体力活动获得有关体力活动模式的详细信息 制定了调查问卷(PPAQ)(NIH/NICHD R03-39341)，并对其在该人群中的使用进行了验证。心理社会 压力将通过自我报告(生活事件、感受到的压力、焦虑、抑郁和自尊)进行评估。 使用在拉丁裔人群中得到验证的量表，以及2)唾液皮质醇，这是对压力做出反应的生理标志。 关于孕前体重指数、饮食、吸烟、药物滥用、医疗和产科病史的信息， 文化适应和社会人口因素也将受到质疑。体重和腰围将是 量过了。在常规超声检查(妊娠18-20周)时进行的两次后续访谈和 GDM筛查(妊娠24-28周)，将更新感兴趣变量的信息并重复唾液 皮质醇收藏。将从队列中选择100名孕妇的胎龄分层样本进行评估 皮质醇测量的日变化。实验报告将摘要用于GDM筛选结果和第四次面试 将在妊娠32-34周时对筛查血糖升高的人进行检查。分娩后，医疗 记录将被提取以确认事件GDM和出生结果。将使用Logistic回归来评估 体力活动、心理社会压力与妊娠期糖尿病风险的关系。边际结构模型将 评估饮食、体脂分布、体重增加和吸烟在关系中的中介变量的作用 压力和妊娠期糖尿病之间的关系。皮质醇将以嵌套病例对照的方式分析116例妊娠期糖尿病病例和 对照样本比例为4：1。二次分析将前瞻性地评估压力和压力之间的关系 以及筛查血糖升高的妇女中的不良生育结果。 建议的研究基于我们在拉丁裔GDM研究(美国糖尿病协会)中的经验 职业奖)，并通过在#年的多个点进行前瞻性评估，扩展了先前调查的工作 妊娠，压力测量的多维方法，以及潜在混杂的详细评估 以及在庞大的高危人群中的中介因素。在这方面利用的多学科研究合作 提案是美国国立卫生研究院医学研究路线图的一个关键组成部分，旨在建立“研究团队” 未来“。

Diabetes and obesity have reached epidemic proportions in the U.S.with rates consistently higher in Latinas than non-Latina whites. Shifting the prevention period for these conditions upstream, to pregnancy, may be an innovative strategy. The major aims of this proposal are to evaluate new and timely hypothesesregarding modifiable determinants of GDM among Latina women. We propose to evaluate the association between external stressors (physical activity), internal stressors (psychosocial stress), and mediators between these variables and risk of GDM. Using a prospective cohort design, 2,300 Latina (predominantly Puerto Rican) prenatal care patients will be recruited from Baystate Medical Center at their first prenatal care visit (8-12 weeks gestation). Bilingual interviewers will obtain detailed information on physical activity patterns via the Pregnancy Physical Activity Questionnaire (PPAQ) (NIH/NICHD R03-39341) developed and validated for use in this population. Psychosocial stress will be assessed through 1) self-report (life events, perceived stress, anxiety, depression, and self-esteem) using scales validated in Latina populations, and 2) salivary cortisol, a physiologic marker of responseto stress. Information on pregravid BMI, diet, cigarette smoking, substance abuse, medical and obstetric history, acculturation, and sociodemographic factors will also be queried. Weight and waist circumferencewill be measured. Two subsequent interviews, conducted at the time of routine ultrasound (18-20 weeks gestation) and GDM screen (24-28 weeks gestation), will update information on the variables of interest and repeat the salivary cortisol collection. A gestational-age stratified sample of 100women from the cohort will be selected to assess diurnal variation in the cortisol measure. Lab reports will be abstracted for GDM screen results and a 4th interview will be conducted at 32-34weeks gestation among those with elevated screening glucose. After delivery, medical records will be abstracted to confirm incident GDMand birth outcomes. Logistic regression will be used to assess the relationship between physical activity, psychosocial stress and GDM risk. Marginal structural models will assess the role of diet, body fat distribution, weight gain, and smoking as mediating variables in the relationship between stress and GDM. Cortisol will be analyzed in a nested case-control fashion on 116 GDM cases and a matched 4:1 sample of controls. A secondary analysis will prospectively assess the relationship betweenstress and adverse birth outcomes in among womenwith elevated screening glucose. The proposed study builds upon our experience in the Latina GDM Study (American Diabetes Association Career Award) and extends the work of prior investigations through prospective assessment at multiple points in gestation, a multidimensional approach to stress measurement, and detailed evaluation of potential confounding and mediating factors in a large, high-risk population. The multidisciplinary research collaboration utilized in this proposal is a key component of the NIH Roadmap for Medical Research in building "Research Teams of the Future".