Exploring the psychosocial predictors of gestational diabetes and birth weight
Background: Pregnant women with strong social support are less likely to experience emotional distress throughout pregnancy and during the postpartum period, leading to improved maternal and newborn well-being. Social support has also been linked to BW: mothers with low social support have a two-fold increased risk of having a low BW infant. Maternal biopsychosocial factors during pregnancy (e.g., Body Mass Index [BMI], diabetes, depression, and intimate partner violence) are also known to affect BW and gestational age; and some biopsychosocial factors increase the likelihood of GDM. Although recent studies have examined the relationship between GDM and depression to adverse birth outcomes, results have been inconsistent and therefore inconclusive. Our goal was to examine what sociodemographic and behavioral variables influenced the likelihood of either GDM or BW; and whether self-reported abuse, stress, or depression affected the likelihood of BW or GDM after controlling for sociodemographic variables.
Methods: The 2009-2011 Utah PRAMS (Pregnancy Risk Assessment Monitoring System) and birth certificate data from the CDC and Utah State Health Department were analyzed and included 3,655 cases, reflecting 131,016 childbearing women. To identify the best predictors of GDM and BW, a hierarchical stepwise logistical regression was conducted. The first model introduced maternal demographics, behaviors, and socioeconomic status as control variables, including ethnicity, race, age, BMI, tobacco and alcohol use during pregnancy, and poverty level. Model two then tested the effects of cumulative stress, depression and abuse after controlling for model one variables.
Results: Maternal race, age and BMI remained significant predictors of GDM across both models. In the final model, non-white women were nearly 3 times more likely to develop GDM. Also for every year increase in maternal age there was a corresponding 5% increase in risk for GDM. Likewise, for every unit increase in BMI, there was a corresponding 6% increase in risk for GDM. Cumulative stress, depression and physical abuse lacked significant predictive value for GDM. Significant predictors for BW were marital status, smoking during the 3rdtrimester, history of a previous preterm baby, use of progesterone prophylaxis, gestational age and maternal BMI. Cumulative stress was the only psychosocial factor that was a significant predictor for BW. For every increase in cumulative stress, there was a corresponding decrease of 15.6 grams in birth weight.
Implications: Healthcare providers often screen for depression or physical abuse in the perinatal period, but screening for stress is less likely to occur. Nurses may be the first providers to recognize stress in a pregnant woman and are likely to be in a position of trust to assess actual stress. Unlike depression and abuse, stress is often overlooked, and this unmet need represents an opportunity for nurses to screen for and assist women with stressors to positively impact birth weight.