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

怀孕是一个关键的人生转变，妇女的心理健康和福祉与她们自己和婴儿的身体健康有着内在的联系。像许多生活的转变一样，怀孕伴随着重大的变化、复杂的决定和压力的增加，这可能会影响应对能力。孕妇的这种脆弱性和沉重的心理负担在患有慢性疾病的情况下更加严重。糖尿病（已存在的1型或2型糖尿病，或妊娠糖尿病）是影响妇女怀孕期间最常见的慢性疾病。2021年，英国有记录的糖尿病患者超过10%。导致活产的妊娠（约65000例）。然而，尽管难以精确量化，但总体影响要大得多，因为流产、先天性畸形和许多孕产妇和新生儿不良结局的风险增加了3-4倍。由于妊娠并发症的风险增加，必须更严格地控制血糖水平以减轻这些风险的挑战，以及治疗变化的影响，在妊娠期间管理糖尿病对孕产妇的焦虑和心理健康产生深远影响。1,8-10鉴于其流行程度和后果，妊娠期糖尿病是心理健康不平等的一个重要驱动因素，是世卫组织、ESRC和MRC确定的一个优先行动领域。因此，了解减轻妊娠期糖尿病心理健康负担的策略是一个优先事项。怀孕期间有规律的身体活动（PA）可以改善心血管健康，降低许多不良妊娠和分娩结果的风险，改善情绪和心理健康。因此，在2019年，英国首席医疗官发布了第一份孕妇PA指南，建议每周进行150分钟的适度PA在妊娠期间，无并发症妊娠妇女的PA水平下降：只有10%的妇女在妊娠三个月达到推荐的活动水平3。对于患有糖尿病的女性来说，达到这个水平的PA是特别困难的。有限的证据表明，大多数人都非常不活跃。医疗保健专业人员（HCPs：助产士、医生、卫生视察员、社区护士）是支持怀孕期间患有糖尿病的妇女的关键。《联合王国产妇审查》设想在怀孕期间根据个人情况提供有效的支持。然而，由于我们的知识存在根本性的差距，目前尚无基于证据的指导来支持妊娠期糖尿病妇女的PA治疗。目前还没有人研究：1：妊娠期间PA模式如何随时间变化，以及这些变化在不同糖尿病诊断和不同背景的妇女中可能有何不同。怀孕期间PA的纵向变化可能与糖尿病管理、情绪和心理健康结果的变化有关。2：怀孕期间糖尿病妇女的生活经历、PA的心理决定因素和对其改善心理健康和福祉的潜力的看法之间的相互作用，以及她们对哪些信息和支持可能最有用的看法。HCPs和其他利益相关者在支持怀孕期间患有糖尿病的妇女方面的经验，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/策略/材料。这一跨学科博士项目将结合证据综合、流行病学和心理学研究方法，以解决上述基本知识差距，并为改善对怀孕期间患有糖尿病的妇女的心理健康的支持提供信息。这将通过整合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