Epidemiology of Stress and GDM among Latina Women

糖尿病和肥胖症在美国已达到流行病的程度，拉丁美洲人的发病率一直较高 非拉丁裔白人。将这些疾病的预防期上游转移到怀孕，可能是一个 创新战略。本建议的主要目的是评估新的和及时的假设， 拉丁裔妇女中GDM的可变决定因素。我们建议评估外部 压力源（体力活动），内部压力源（心理压力），以及这些变量之间的中介， GDM的风险 使用前瞻性队列设计，将对2，300名拉丁裔（主要是波多黎各人）产前护理患者进行 在第一次产前检查时（妊娠8-12周）从Baystate医疗中心招募。双语 访谈者将通过孕期体力活动获得有关体力活动模式的详细信息。 开发并验证了用于该人群的调查问卷（PPAQ）（NIH/NICHD R 03 -39341）。心理社会 压力将通过1）自我报告（生活事件，感知压力，焦虑，抑郁和自尊）进行评估 使用在拉丁裔人群中验证的量表，和2）唾液皮质醇，应激反应的生理标志物。 妊娠前BMI、饮食、吸烟、药物滥用、病史和产科史的信息， 文化适应和社会人口因素也将受到质疑。体重和腰围将是 测定了随后的两次访谈，在常规超声检查时进行（妊娠18-20周）， GDM筛查（妊娠24-28周），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例孕龄分层样本， 皮质醇测量的昼夜变化。将提取实验室报告用于GDM筛查结果和第4次访谈 将在筛选血糖升高的受试者中于妊娠32- 34周进行。分娩后，医疗 将提取记录以确认事件GDM和出生结局。逻辑回归将用于评估 体力活动、心理社会压力与GDM风险之间的关系。边际结构模型将 评估饮食、身体脂肪分布、体重增加和吸烟作为关系中的中介变量的作用 压力和GDM之间的关系皮质醇将以巢式病例对照的方式对116例GDM病例进行分析， 4：1匹配的对照样品。二次分析将前瞻性地评估压力与 和不良的出生结果。 这项研究建立在我们在拉丁裔GDM研究（美国糖尿病协会）的经验基础上 职业奖），并通过在多个地点进行前瞻性评估， 妊娠期，压力测量的多维方法，以及潜在混杂因素的详细评估 和介导因素。多学科的研究合作，在此使用 该提案是NIH医学研究路线图的一个关键组成部分， 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".