Dissertation/Thesis Abstract

Risk Factors for Gestational Diabetes in Upstate New York Women & Implications for Practice
by Versteegen, Margaret, Dr.P.H., State University of New York at Albany, 2019, 165; 27546317
Abstract (Summary)

Gestational diabetes mellitus (GDM) is a form of diabetes, or abnormal blood glucose (sugar) metabolism, diagnosed during pregnancy. Pregnant, non-diabetic women who are initially noted to experience high blood glucose levels during their pregnancy are considered to have GDM (ADA, 2016b). GDM has significant implications for infant and maternal morbidity and mortality, with adverse pregnancy outcomes such as infant macrosomia, difficult birth requiring cesarean section, and postpartum hemorrhage (Kamana, Shakya, & Zhang, 2015). In the majority of cases, GDM goes away once the baby is born, but around 5–10% of women with GDM go on to have type 2 diabetes immediately following their pregnancy (NIH, 2006). Having GDM presents a 20–50% increased risk for developing type 2 diabetes later on in life (CDC, 2017; NIH, 2006), increased stress levels (Hayase, Shimada, & Seki, 2014), and increased risk for postpartum depression (Hinkle et al., 2016). Increased risks to the child include greater chance for obesity as well as developing type 2 diabetes (CDC, 2017; NIH, 2006).

GDM is becoming an increasingly common pregnancy complication with prevalence estimates around 9.2% of all United States (US) pregnancies (DeSisto, Kim, & Sharma, 2014) and 10.3% of New York State (NYS) pregnancies (NYS DOH, 2016b). GDM is a cross-cutting issue, as it relates to multiple NYS Prevention Agenda priorities including chronic disease prevention, the promotion of healthy women, infants and children, the promotion of maternal well-being, and potentially the prevention of mental disorders (NYS DOH, 2018b).

While it is possible for any pregnant woman to develop GDM, evidence has shown certain factors increase risk, like higher age and body mass indices (BMIs). However, even within the commonly implicated GDM risk factors there is wide variation in associations between populations; of women diagnosed with GDM, only around half report any recognized risk factors (Dode & Santos, 2009). Further research with specific populations can serve to monitor trends, clarify risk factors, and better plan health care services and policies to help focus screening and prevention efforts. The Albany Infant and Mothers Study (AIMS; Appleton, Kiley, Holdsworth, & Schell, 2019) is an observational, prospective cohort study being conducted by Dr. Allison Appleton in upstate New York (NY), collecting a rich variety of data from pregnant women including maternal stressors during and prior to their pregnancy. For this study, typically cited GDM risk factors in the AIMS participants were examined and compared in those with and without a GDM diagnosis, including maternal age and pre-pregnancy body mass index (BMI), thus adding to the GDM evidence base. Additionally, psychosocial factors like adverse childhood experiences (ACEs), depression, and level of social support and their relationship with GDM development were explored, in response to related and emerging evidence of associations (Mason et al., 2016; Bowers et al., 2013; Horsch et al., 2016; Hinkle et al., 2016; Mizuno et al., 2016).

Through the lens of the life course theory (Lu & Halfon, 2003), the biopsychosocial model (Engel, 1977) was used as the guiding framework for this study. This viewpoint allows for the appreciation of the individual and their biological, social, and psychological environments across their lifespan in a collective sense, providing a more complete picture of growth, development, and disease. Additionally, the concepts of allostasis and allostatic load (McEwen, 1998) add further context and support to the biopsychosocial framework.

The aims of this study were to assess the prevalence of GDM in a diverse subset of women from the AIMS study in upstate NY, and to determine its associations with a variety of GDM risk factors in this population, including maternal age, race/ethnicity, BMI, medical history, and socioeconomic characteristics. Additionally, potential behavioral and psychosocial factors that may be contributing to GDM risk were explored.

Bivariate analyses showed women with a pre-pregnancy body mass index (BMI) ≥ 30 (p ≤ 0.001), age ≥ 30 (p ≤ 0.05), or a history of GDM in a prior pregnancy (p ≤ 0.001) were at increased risk for GDM. Logistic regression modeling estimated the odds ratios (ORs) of developing GDM in relation to psychosocial factors. There was a significant association between depression and GDM (OR = 2.85, 95% CI: 1.15, 7.06), which persisted in the model adjusted for age and BMI (aOR = 3.19, 95% CI: 1.25, 8.10). Non-significant trends towards increased risk for GDM with higher ACE scores and lower levels of social support were also evident.

These findings underscore the importance of considering both psychosocial factors and biological variables in GDM development. Further investigation of these factors in larger, diverse populations is warranted, including examination of the impact of interventions at various time-points throughout the life course. Taking a holistic, biopsychosocial approach may prove effective in guiding future research and intervention efforts to address pregnancy complications like GDM.

Indexing (document details)
Advisor: Bozlak, Christine
Commitee: Appleton, Allison, Larkin, Heather
School: State University of New York at Albany
Department: Health Policy, Management and Behavior
School Location: United States -- New York
Source: DAI-B 81/5(E), Dissertation Abstracts International
Subjects: Public health, Obstetrics, Epidemiology
Keywords: Adverse childhood experiences, Biopsychosocial model, Gestational diabetes mellitus, Maternal depression, Maternal well-being, Psychosocial factors
Publication Number: 27546317
ISBN: 9781392830994
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