Study On The Relationship Between Psychological Stress And Glucolipid Metabolism During Pregnancy

Background:In recent years,the prevalence of gestational diabetes mellitus(GDM)worldwide has posed a great challenge to global public health.The previously recognized risk factors for GDM mainly include maternal age≥35 years,obesity,family history of diabetes,and previous GDM history.However,some researchers have found that these factors do not exist in nearly half of GDM patients.Pregnancy makes pregnant women in a high degree of stress,forming unique and complex psychological characteristics and problems.Therefore,regular psychological counseling and counseling for pregnant women may help to improve abnormal glucose and lipid metabolism during pregnancy.Objective:(1)Quantitative comprehensive evaluation of the research results on the relationship between blood lipids in early pregnancy and GDM,with a view to providing evidence-based medical evidence for better health care of pregnant women.(2)To understand the psychological stress level and sleep quality of pregnant women in early pregnancy,collect their venous blood to detect plasma 5-hydroxytryptamine(5-HT)level,and combine demographic characteristics to analyze the correlation between various psychological stress indicators;(3)To analyze the changes in stress perception and sleep conditions of pregnant women during different pregnancies,and explore the relationship between psychological stress and blood glucose,lipid levels and the risk of GDM.Methods:(1)Meta analysis:searching all the domestic and foreign published original literature on blood lipid levels and GDM,and databases including CNKI,Wanfang Data,China Biomedical Literature Database,Pubmed,Web of Science were searched from inception to February 2020.The Newcastle-Ottawa quality assessment scale(NOS)was used to evaluate the quality of the literature.Stata/MP 14.0 software was used for statistical analysis and processing,and weighted mean difference(WMD)was selected as the combined effect size for analysis.Heterogeneity test was conducted with I~2 in the included studies,and possible sources of heterogeneity were analyzed in subgroups.At the same time,sensitivity analysis was conducted to check the stability of the results.The Egger test was used to assess publication bias.(2)The study design includes a cross-sectional study and a nested case-control study.The research subjects were pregnant women who established the maternal health care manual in the maternal and child health center of gulou district,nanjing city,jiangsu province from April to December 2019.The investigators issued the"Maternal Health Questionnaire"to pregnant women who met the selection criteria.The relevant contents that can be learned in conjunction with the Maternal Health Handbook and the pregnant woman information registration form are:general demographic data,pregnancy wishes,pre-pregnancy examinations,sensory pressure and sleep situation,etc during pregnancy.The Perceived Stress Scale(PSS)of 14 items and Pittsburgh Sleep Quality Index(PSQI)were used to evaluate the Sleep Quality of pregnant women in the last1 month.Telephone follow-up of the pregnant women in the third trimester(from 35 weeks of gestation to before delivery)was carried out,including the pressure perception,sleep situation and perinatal diseases such as GDM,gestational hypertension,and gestational anemia.Using descriptive analysis research methods to analyze the pressure perception and sleep condition of pregnant women in early pregnancy,compare the demographic characteristics of pregnant women under different stress levels and different sleep quality,and use Logistic regression model to analyze the influencing factors of stress and sleep quality.Pearson correlation analysis was performed on the stress perception scale and sleep scale.The level of plasma 5-HT was detected by ELISA,and the differences in 5-HT levels among pregnant women with different demographic characteristics,pressure perception level and sleep quality were analyzed and compared,so as to explore the relationship between stress level,sleep quality and 5-HT level.A nested case-control study was carried out on pregnant women with GDM during follow-up in the third trimester of pregnancy.The matched control group was selected from pregnant women without GDM in the cohort at a ratio of 1:3 according to the age of the case group(±2 years old)to analyze the relationship between pregnancy stress perception,sleep quality and blood glucose,blood lipid levels and the risk of GDM.Results:(1)Meta analysis:72 articles were finally included,and a total of 14621 GDM patients and 46692healthy controls were obtained.The correlation analysis of TC,TG,HDL-C,LDL-C and GDM was included in 66,71,40,and 38 literatures respectively,and the combined effect size WMD value and 95%CI were0.291(0.223,0.359),0.369(0.357,0.412),-0.119(-0.179,-0.058)and 0.203(0.158,0.249),the results showed statistical significance(P<0.05).It suggested that high levels of TC,TG and LDL-C in early pregnancy would increase the risk of GDM,while high levels of HDL-C would reduce the risk of GDM(2)The pregnant women who has established maternal health manual and met the inclusion criteria were390,excluding 20 incomplete information,and finally included 370 subjects in this study.The age of pregnant women was concentrated between 25 and 35 years old,with an average age of(29.90±4.16)years old.The overall score of the 370 pregnant women’s stress perception scale in this study was(2～37)points,and the average score was(20.04±7.0)points.In the study,there were 266 pregnant women in the low pressure perception group,accounting for 71.9%;104 patients in the high pressure perception group,accounting for28.1%.The analysis of the influencing factors of pressure perception showed that low education level was a risk factor for the occurrence of high pressure perception.The risk of high pressure perception among high school or below pregnant women was 2.37 times(OR=2.37,P=0.002)higher than that of pregnant women with graduate degree or above.The risk of high-stress perception was 1.83 times(OR=1.83,P=0.019)that of pregnant women who had no previous history of adverse pregnancy.The PSQI score of 370 pregnant women in this study was(0～15)points,with an average of(5.73±2.55)points.Sleep problems were mainly manifested in three dimensions:sleep latency,sleep disturbance and daytime dysfunction.Their average scores were(1.01±0.89),(1.21±0.51)and(1.79±0.93),which were all greater than 1.The sleep quality of pregnant women was significantly lower than that of non-pregnant people.The specific sleep problems were manifested in poor subjective sleep quality,sleep disorders and daytime dysfunction,etc.There were 85 pregnant women with PSQI score>7,and the incidence of sleep disturbance of was 23.0%.The analysis results of factors affecting sleep quality showed that birth order and pressure perception were related to the occurrence of sleep disorders in pregnant women.The occurrence risk of sleep disorders in pregnant women was 0.53 times higher than that in pregnant women without a history of childbirth(OR=0.53,P=0.018).Pregnant women with high pressure perception were 2.11 times more likely to have sleep disturbances than pregnant women with low pressure perception(OR=2.11,P=0.005).The median and interquartile range of plasma 5-HT levels of 370 pregnant women in this study were384.28(285.01～506.96)ng/ml.There was not significant difference in plasma 5-HT among different age groups(P>0.05).Similarly,the difference in plasma 5-HT levels between the first and non-first trimester was not statistically significant(P>0.05).There was no significant difference in 5-HT levels among pregnant women of different gestational weeks and parity(P>0.05).There were no significant differences in 5-HT levels among people with different pressure-sensing states and the presence or absence of sleep disorders(P>0.05).(3)Taking pregnant women with low pressure perception as a control group,the pressure perception level showed no statistical significance between control group and GDM group before or after adjusting confounding factors(P>0.05).According to the changes in the level of pressure perception during the first and third trimesters,four changes in pressure perception during pregnancy were obtained,namely,low pressure,increased pressure,improved pressure and high pressure.The risk of GDM was 5.09 times higher in women with elevated levels of perceived stress during pregnancy than in the control group(95%CI:1.25-20.83,P=0.023).The total score of sleep scale in GDM patients in the third trimester(8.43±4.15)was significantly higher than that in the non-GDM patients(4.96±2.65)(t=-5.149,P<0.001).From the dimensions of the sleep scale,except for the sleep latency dimension,the scores of the other dimensions of the GDM group were significantly higher than the non-GDM group(P<0.01),Among them,the average scores of sleep continuity,sleep efficiency and daytime dysfunction were significantly different between the two groups.Nighttime sleep time of less than 7 hours could increase the risk of GDM.Pregnant women with sleep time of less than7 hours before and after adjusting related confounding factors were 5.67 times more likely to have GDM than the control group(95%CI:2.25～14.30,P<0.001)and 4.37 Times(95%CI:1.62～11.76,P=0.004).The risk of GDM in pregnant women with sleep disorders was 9.71 times(95%CI:3.68～25.62,P<0.001)and9.55 times(95%CI:3.34～27.26,P=0.004).Both the decrease in sleep quality during pregnancy and the poorer levels could increase the risk of GDM.The risk of GDM in pregnant women with reduced sleep quality during pregnancy before and after adjusting for confounding factors was 9.75 times that of the control group(95%CI:3.23～29.48,P<0.001)and 9.87 times(95%CI:3.03～32.14,P<0.001);Pregnant women who had poor sleep quality during pregnancy before and after adjusting for confounding factors had a 9.00 times risk of GDM compared to the reference group(95%CI:2.23～36.40,P=0.002)And 7.77 times(95%CI:1.59～38.05,P=0.011).Conclusions:(1)Meta-analysis evidence shows that high levels of TC,TG and LDL-C in the first trimester could increase the risk of GDM,and high levels of HDL-C were protective factors for GDM.(2)The incidence of high-stress perception in pregnants reached 28.1%.Low education level and poor pregnancy history were the risk factors for high-stress perception.Pregnant women generally had poorer sleep quality than non-pregnant adult pregnant women.The incidence of sleep disturbance in pregnant women was 23%,and the incidence of sleep disturbance was higher in first trimesters and first birth pregnant women.Sleep-specific problems were mainly in sleep latency,sleep disturbances,and daytime dysfunction.Pregnant women with high levels of stress perception were more likely to have trouble sleeping.(3)The pressure perception and tension in the GDM group in the third trimester was higher than that of the non-GDM group;The sleep situation was worse than that in the normal adults group.Increased levels of stress perception and poor sleep quality could increase the risk of GDM.Sleep duration more than 7 hours is a protective factor for GDM.The risk of GDM in pregnant women with sleep time less than 7 hours was significantly higher than that for pregnant women with sleep duration more than 7 hours.