BOSTON (FRONTLINE MEDICAL NEWS) Psychosocial stress is an independent risk factor for excess weight gain among women with gestational diabetes mellitus, findings from the Gestational Diabetes Effects on Moms (GEM) study suggest.

Among nearly 1,300 women in the cluster randomized trial conducted within Kaiser Permanent Northern California, perceived stress near the time of gestational diabetes diagnosis at around 32 weeks’ gestation was significantly associated with a risk of excess gestational weight gain.

After adjusting for gestational and maternal age at the time of gestational diabetes diagnosis, education level, pregravid body mass index, and race/ethnicity, an upper-quartile score on the Perceived Stress Scale (PSS), compared with a lower score, was associated with a 54% increased odds of weight gain that exceeded Institute of Medicine recommendations (odds ratio, 1.54), Ai Kubo, Ph.D., of Kaiser Permanente in Oakland, Calif., reported at the annual scientific sessions of the American Diabetes Association.

A significant trend between PSS score and gestational weight gain was seen, and the association was not attenuated by inclusion of other lifestyle variables, including diet and physical activity, Dr. Kubo said, noting that no association was seen between PSS and the odds of gaining weight at a level below the IOM recommendations.

Dr. Kubo and her colleagues examined the relationship between stress and weight gain using baseline data from the GEM study. Subjects were women who delivered a term singleton at greater than 37 weeks’ gestation. Total gestational weight gain (about 20 pounds on average) and prepregnancy body mass index were obtained from electronic health records. Weight gain was categorized according to 2009 IOM recommendations.

Women with lower socioeconomic status tended to be in the highest stress group, and although there was no significant differences in prepregnancy weight between the highest and lowest stress groups, more of those with BMIs over 35 were in the highest stress group, she noted.

“Excess gestational weight gain has become an important public health concern,” Dr. Kubo said, noting that nearly 60% of women exceed IOM recommendations for weight gain, which increases the risk of adverse health outcomes, including obesity, in both women and their offspring.

Gestational diabetes mellitus occurs in about 8% of all pregnant women and also increases the risk of adverse outcomes in both mothers and offspring, she said.

The current findings suggest that stress reduction interventions may be warranted in women with gestational diabetes mellitus to optimize weight gain and possibly reduce the risks to both mother and offspring, she said, noting that the study is limited by a lack of assessment regarding the timing of stress relative to weight gain and gestational diabetes diagnosis.

“For future studies, use of a [non–gestational diabetes] population, and assessment of stress at the beginning of the pregnancy or even prior to the pregnancy would help us better understand the role of psychosocial stress on weight gain during pregnancy,” she said.

Dr. Kubo reported having no disclosures.


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