Maternal stress and blood sugar metabolization during pregnancy, and associations with adverse outcomes.

妊娠期糖尿病（GDM）影响估计3%至9%的妊娠，增加了严重并发症的风险。 母亲和孩子的健康并发症。已确定的发生GDM的风险因素包括个体 特性（例如，较高的体重指数，高龄产妇）和遗传因素（例如，家族史 2型糖尿病，历史上被边缘化的种族/民族身份）。然而，大约50%的GDM诊断 在没有任何已知风险因素的情况下发生。与葡萄糖相关的生物心理社会因素的补充研究 代谢，如心理健康和压力过程，可能有助于识别处于风险中的个人。我们假设 孕妇心理健康、糖代谢和GDM相关不良反应之间存在关联， 妊娠结局受压力调节，这些相关性的程度与GDM相关。 非裔美国人（AA）和美洲原住民（NA）妇女与非裔美国人相比， 西班牙裔白色（NHW）女性。这个项目将：1）确定与压力相关的变量，调节协会 产妇心理健康和GDM相关的健康结果之间的关系; 2）描述产妇心理健康和GDM相关的健康结果之间的关系。 精神健康、压力、葡萄糖代谢和相关不良结果在AA、NA和NHW之间存在差异 妇女;和3）增加我们对心理生理应激反应如何与孕产妇相互作用的理解 压力和心理健康，预测妊娠期间葡萄糖代谢，以及与不良反应的关系 围产期结果。桑福德医院4,845份妊娠相关病历的回顾性分析 健康患者，以及一项前瞻性研究，其中包括150名孕妇从桑福德健康产前招募 护理人员将进行。来自医疗记录和前瞻性评估的数据将用于识别 孕产妇健康、心理健康、血糖代谢和妊娠结局之间的关系。 压力指标将作为这些关联的调节因素进行测试。这些分析将确定哪些组合 母亲抑郁、焦虑和压力与GDM和GDM相关结果的风险增加有关。 这项回顾性研究将比较NA、AA和NHW妇女中模型关联的影响 遗产，结果将提供洞察力的作用，心理社会因素在GDM相关的健康差距 在AA和NA女性中。在前瞻性研究中，参与者将完成一项实验室压力任务， 应激反应的生理标志物。前瞻性研究的结果将提供有关 产妇心理健康和压力影响血糖的生理途径的作用 代谢我们的目标是提高我们的能力，以确定妇女的风险和预防GDM和相关并发症。

Gestational diabetes mellitus (GDM) impacts an estimated 3% to 9% of pregnancies, increasing the risk of serious health complications for mother and child. The identified risk factors for developing GDM include both individual characteristics (e.g., higher body mass index, advanced maternal age) and heritable factors (e.g., family history of Type 2 diabetes, historically marginalized racial/ethnic identity). However, approximately 50% of GDM diagnoses occur in the absence of any known risk factor(s). Additional research on biopsychosocial factors related to glucose metabolism, such as mental health and stress processes, may help to identify individuals at risk. We hypothesize that there will be associations between maternal mental health, glucose metabolization, and GDM related adverse pregnancy outcomes that are moderated by stress, and that the magnitude of the of these associations underlay GDM health disparities experienced by African American (AA) and Native American (NA) women in comparison to non- Hispanic white (NHW) women. This project will: 1) identify stress-related variables that moderate associations between maternal mental health and GDM-related health outcomes; 2) delineate associations among maternal mental health, stress, glucose metabolization, and related adverse outcomes, differ among AA, NA, and NHW women; and 3) increase our understanding of how psychophysiological stress reactivity interacts with maternal stress and mental health, to predict glucose metabolization during pregnancy, and associations with adverse perinatal outcomes. A retrospective study of 4,845 de-identified pregnancy-related medical records of Sanford Health patients, and a prospective study which follows 150 pregnant women recruited from Sanford Health prenatal care providers will be conducted. Data from medical records and prospective assessments will be used to identify associations between maternal health, mental health, blood glucose metabolization and pregnancy outcomes. Indicators of stress will be tested as moderators in these associations. These analyses will identify which combinations of maternal depression, anxiety, and stress, are associated with increased risk of GDM and GDM related outcomes. The retrospective study will compare the impact of modeled associations, among women of NA, AA, and NHW heritage, with results that will provide insights as to the role of psychosocial factors in GDM related health disparities among AA and NA women. The prospective study, participants will complete a laboratory stress task while we assess physiological markers of stress reactivity. Results from the prospective study will provide novel information about the role of physiological pathways by which combinations of maternal mental health and stress impact blood sugar metabolization. We aim to improve our ability to identify women at risk and prevent GDM and related complications.