Epidemiology of Stress and GDM among Latina Women

描述（由申请人提供）：糖尿病和肥胖症在美国已达到流行病的比例，拉丁裔的发病率始终高于非拉丁裔白人。将这些疾病的预防期转移到上游，怀孕，可能是一种创新的战略。这项建议的主要目的是评估新的和及时的假设，关于拉丁妇女GDM的可修改的决定因素。我们建议评估外部压力源（体力活动），内部压力源（心理社会压力），这些变量和GDM的风险之间的介质之间的关联。 采用前瞻性队列设计，将在第一次产前护理访视（妊娠8-12周）时从Baystate医疗中心招募2，300名拉丁裔（主要是波多黎各人）产前护理患者。双语采访者将通过为该人群开发并验证的怀孕身体活动问卷（PPAQ）（NIH/NICHD R 03 -39341）获得有关身体活动模式的详细信息。将通过以下方式评估心理社会压力：1）使用在拉丁裔人群中验证的量表进行自我报告（生活事件、感知压力、焦虑、抑郁和自尊），以及2）唾液皮质醇，一种应激反应的生理标志物。还将询问关于妊娠前BMI、饮食、吸烟、药物滥用、医疗和产科史、文化适应和社会人口学因素的信息。将测量体重和腰围。在常规超声（妊娠18-20周）和GDM筛查（妊娠24-28周）时进行的两次后续访谈将更新有关感兴趣变量的信息，并重复唾液皮质醇收集。将从队列中选择100名女性的妊娠年龄分层样本，以评估皮质醇测量的昼夜变化。将提取GDM筛查结果的实验室报告，并在妊娠32-34周时对筛查血糖升高的受试者进行第4次访视。分娩后，将提取医疗记录，以确认GDM事件和出生结局。Logistic回归将用于评估体力活动，心理社会压力和GDM风险之间的关系。边缘结构模型将评估饮食、体脂分布、体重增加和吸烟作为压力和GDM之间关系的中介变量的作用。皮质醇将以巢式病例对照方式对116例GDM病例和匹配的4：1对照样本进行分析。二次分析将前瞻性地评估筛查血糖升高的妇女中压力和不良分娩结局之间的关系。 拟议的研究以我们在拉丁裔GDM研究（美国糖尿病协会职业奖）中的经验为基础，并通过妊娠多个时间点的前瞻性评估、压力测量的多维方法以及对潜在混杂因素的详细评估来扩展先前调查的工作。和大量高危人群中的中介因素。本提案中使用的多学科研究合作是NIH医学研究路线图在建立“未来研究团队”方面的关键组成部分。

DESCRIPTION (provided by applicant): 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 hypotheses regarding 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 response to 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 circumference will 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 100 women 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 32-34 weeks gestation among those with elevated screening glucose. After delivery, medical records will be abstracted to confirm incident GDM and 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 between stress and adverse birth outcomes in among women with 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".