The Complex Relationship between Stress and Gestational Diabetes: Mechanisms and Interventions for Maternal and Fetal Health

Document Type : Scientific Review

Authors

1 Department of Obstetrics and Gynecology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran

Abstract

Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy that poses risks to both maternal and fetal health. This study aims to elucidate the intricate relationship between stress and the development of GDM, highlighting how stress-related hormonal fluctuations and behavioral changes—such as increased cortisol levels, inflammation, disrupted sleep patterns, and poor dietary choices—contribute to insulin resistance and glucose dysregulation. We examine the influence of stress on hormonal and lifestyle factors associated with GDM and evaluate interventions that manage stress-related metabolic disturbances. Elevated levels of stress hormones (like cortisol and adrenaline) and inflammatory markers (such as IL-6 and TNF-α) are linked to an increased risk of GDM due to their detrimental effects on insulin sensitivity. Our findings suggest that effective interventions, including mindfulness practices, cognitive-behavioral therapy, and regular physical activity, can reduce cortisol levels and enhance glucose regulation. This underscores the necessity of addressing both the metabolic and psychological dimensions of GDM. Current evidence supports the integration of stress-reduction strategies—such as mindfulness, cognitive-behavioral therapy, and exercise—into GDM management, as they can improve glycemic control by lowering cortisol and enhancing insulin sensitivity. Recognizing stress as a modifiable risk factor for GDM is crucial for improving maternal and fetal outcomes, emphasizing the importance of incorporating stress management into GDM prevention and treatment protocols.

Keywords

Corresponding Author: Sedigheh Ekraminasab

View Orcid in Profile
You can search for this author in PubMed     Google Scholar Profile

References

  1. Modzelewski R, Stefanowicz-Rutkowska M, Matuszewski W, Bandurska-Stankiewicz E. Gestational Diabetes Mellitus—Recent Literature Review. J Clin Med 2022; 11(19): 5736.
  2. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018; 19(11): 3342.
  3. Kesler H, Lohmeier K, Hoehn T, Kribs A, Peinemann F. Thin-catheter surfactant application for respiratory distress syndrome in spontaneously breathing preterm infants: a meta-analysis of randomized clinical trials. Curr Pediatr Rev 2022; 18(4): 286-300.
  4. Silva CM, Arnegard ME, Maric-Bilkan C. Dysglycemia in pregnancy and maternal/fetal outcomes. J Womens Health (Larchmt) 2021; 30(2): 187–93.
  5. Ikoh Rph CL, Tang Tinong R. The incidence and management of type 2 diabetes mellitus after gestational diabetes mellitus. Cureus 2023; 15(8): e44468.
  6. Silverstein-Metzler MG, Frye BM, Justice JN, Clarkson TB, Appt SE, Jeffrey Carr J, et al. Psychosocial stress increases risk for type 2 diabetes in female cynomolgus macaques consuming a western diet. Psychoneuroendocrinology 2022; 139: 105706.
  7. Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM 2020; 2(4): 100229.
  8. Márquez-Valadez B, Valle-Bautista R, García-López G, Díaz NF, Molina-Hernández A. Maternal diabetes and fetal programming toward neurological diseases: beyond neural tube defects. Front Endocrinol (Lausanne) 2018; 9: 664.
  9. Lim PQ, Lai YJ, Ling PY, Chen KH. Cellular and molecular overview of gestational diabetes mellitus: Is it predictable and preventable? World J Diabetes 2023; 14(11): 1693–709.
  10. Kuo T, McQueen A, Chen TC, Wang JC. Regulation of Glucose Homeostasis by Glucocorticoids. Adv Exp Med Biol 2015; 872: 99–126.
  11. Tozour J, Hughes F, Carrier A, Vieau D, Delahaye F. Prenatal hyperglycemia exposure and cellular stress, a sugar-coated view of early programming of metabolic diseases. Biomolecules 2020; 10(10): 1359.
  12. Saucedo R, Ortega-Camarillo C, Ferreira-Hermosillo A, Díaz-Velázquez MF, Meixueiro-Calderón C, Valencia-Ortega J. Role of oxidative stress and inflammation in gestational diabetes mellitus. Antioxidants (Basel, Switzerland) 2023; 12(10): 1812.
  13. Zeinabeh MZ, Atefeh A, Masumeh GHP, Tania D, Mojgan S, Katayoun A. The effect of mindfulness-based stress reduction counseling on blood glucose and perceived stress in women with gestational diabetes. Rev Bras Ginecol Obstet 2023; 45(9): e517-e523.
  14. Liu Y, Li DY, Bolatai A, Wu N. Progress in research on biomarkers of gestational diabetes mellitus and Diabetes Metab Syndr Obes 2023; 16: 3807–15.
  15. Kivimäki M, Bartolomucci A, Kawachi I. The multiple roles of life stress in metabolic disorders. Nat Rev Endocrinol 2023; 19(1): 10–27.
  16. Seal S V, Turner JD. The “Jekyll and Hyde” of Gluconeogenesis: Early Life Adversity, Later Life Stress, and Metabolic Disturbances. Int J Mol Sci 2021; 22(7): 3344.
  17. Mosili P, Mkhize BC, Sibiya NH, Ngubane PS, Khathi A. Review of the direct and indirect effects of hyperglycemia on the HPA axis in T2DM and the co-occurrence of depression. BMJ open diabetes Res care 2024; 12(1): e003218.
  18. Smith SM, Vale WW. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues Clin Neurosci 2006;8 (4): 383–95.
  19. Janssen JAMJL. New Insights into the Role of Insulin and Hypothalamic-Pituitary-Adrenal (HPA) Axis in the Metabolic Syndrome. Int J Mol Sci 2022; 23(15): 8178.
  20. Hinds JA, Sanchez ER. The role of the Hypothalamus–Pituitary–Adrenal (HPA) axis in test-induced anxiety: assessments, physiological responses, and molecular details. Stresses 2022; 2(1): 146–55.
  21. Tien Nguyen S, Bui Minh T, Trung Dinh H, Dinh Le T, Phi Thi Nguyen N, Tran TTH, et al. Relationship between maternal serum cortisol and maternal insulin resistance and fetal ultrasound characteristics in gestational diabetes mellitus. Diabetes Metab Syndr Obes 2023; 16: 365–72.
  22. Nara H, Watanabe R. Anti-inflammatory effect of muscle-derived interleukin-6 and its involvement in lipid metabolism. Int J Mol Sci 2021; 22(18): 9889.
  23. Oguntibeju OO. Type 2 diabetes mellitus, oxidative stress and inflammation: examining the links. Int J Physiol Pathophysiol Pharmacol 2019; 11(3): 45–63.
  24. Tangvarasittichai S. Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes 2015; 6(3): 456–80.
  25. Usman TO, Chhetri G, Yeh H, Dong HH. Beta-cell compensation and gestational diabetes. J Biol Chem 2023; 299(12): 105405.
  26. Gilbert L, Gross J, Lanzi S, Quansah DY, Puder J, Horsch A. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review. BMC Pregnancy Childbirth 2019; 19(1): 60.
  27. Singh T, Ahmed TH, Mohamed N, Elhaj MS, Mohammed Z, Paulsingh CN, et al. Does insufficient sleep increase the risk of developing insulin resistance: a systematic review. Cureus 2022; 14(3): e23501.
  28. Sparks JR, Ghildayal N, Hivert MF, Redman LM. Lifestyle interventions in pregnancy targeting GDM prevention: looking ahead to precision medicine. Diabetologia 2022; 65(11): 1814–24.
  29. Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull 2021; 138(1): 41–57.
  30. Wang S, Zhang C, Sun M, Zhang D, Luo Y, Liang K, et al. Effectiveness of mindfulness training on pregnancy stress and the hypothalamic-pituitary-adrenal axis in women in China: A multicenter randomized controlled trial. Front Psychol 2023; 14: 1073494.
  31. Le DC, Vu TB, Tran TN, Nguyen TL, Nguyen TB, Nguyen DC, et al. The effectiveness of lifestyle changes in glycemic control among pregnant women with gestational diabetes mellitus. Medicina (Kaunas) 2023; 59(9): 1587.
  32. Youngwanichsetha S, Phumdoung S, Ingkathawornwong T. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Appl Nurs Res 2014; 27(4): 227–30.
  33. Tsitsou S, Athanasaki C, Dimitriadis G, Papakonstantinou E. Acute effects of dietary fiber in starchy foods on glycemic and insulinemic responses: a systematic review of randomized controlled crossover trials. Nutrients 2023; 15(10): 2383.
  34. Dandjinou M, Sheehy O, Bérard A. Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case-control study. BMJ Open 2019; 9(9): e025908.
  35. Lebin LG, Novick AM. Selective Serotonin Reuptake Inhibitors (SSRIs) in pregnancy: an updated review on risks to mother, fetus, and child. Curr Psychiatry Rep 2022; 24(11): 687–95.
  36. Soucy NL, Terrell RM, Chedid RA, Phillips KP. Best practices in prenatal health promotion: Perceptions, experiences, and recommendations of Ottawa, Canada, prenatal key informants. Womens Health (Lond) 2023; 19: 17455057231158224.
  37. AlSomali Z, Bajamal E, Esheaba O. The effect of structured antenatal education on childbirth self-efficacy. Cureus 2023; 15(5): e39285.
  38. McIntyre HD, Fuglsang J, Kampmann U, Knorr S, Ovesen P. Hyperglycemia in pregnancy and women’s health in the 21st century. Int J Environ Res Public Health 2022; 19(24): 16827.
  39. Catalano PM. The impact of gestational diabetes and maternal obesity on the mother and her J Dev Orig Health Dis 2010; 1(4): 208–15.
  40. Askari M, Dadbinpour A, Ekraminasab S SM. Incidence and risk factors related to gestational diabetes mellitus among women in yazd: a prospective cohort study. World J Peri Neonatol 2022; 5(2): 65–73.
  41. Krishnaveni GV, Veena SR, Jones A, Srinivasan K, Osmond C, Karat SC, et al. Exposure to maternal gestational diabetes is associated with higher cardiovascular responses to stress in adolescent indians. J Clin Endocrinol Metab 2015; 100(3): 986–93.
  42. Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med 2013; 6(2): 52–7.
  43. Stephens MAC, Wand G. Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol Res 2012; 34(4): 468–83.
  44. Kassotaki I, Valsamakis G, Mastorakos G, Grammatopoulos DK. Placental CRH as a Signal of Pregnancy Adversity and Impact on Fetal Neurodevelopment. Front Endocrinol (Lausanne) 2021; 12: 714214.
  45. Nonogaki K. New insights into sympathetic regulation of glucose and fat metabolism. Diabetologia 2000; 43(5): 533–49.
  46. Torres-Torres J, Monroy-Muñoz IE, Perez-Duran J, Solis-Paredes JM, Camacho-Martinez ZA, Baca D, et al. Cellular and molecular pathophysiology of gestational diabetes. Int J Mol Sci 2024; 25(21): 11641.
  47. Bhatti JS, Sehrawat A, Mishra J, Sidhu IS, Navik U, Khullar N, et al. Oxidative stress in the pathophysiology of type 2 diabetes and related complications: Current therapeutics strategies and future perspectives. Free Radic Biol Med 2022; 184: 114–34.
  48. Thakur A, Agrawal S, Chakole S, Wandile B. A critical review of diagnostic strategies and maternal offspring complications in gestational diabetes mellitus. Cureus 2023; 15(12): e51016.
  49. Mrozek W, Socha J, Sidorowicz K, Skrok A, Syrytczyk A, Piątkowska-Chmiel I, et al. Pathogenesis and treatment of depression: Role of diet in prevention and therapy. Nutrition 2023; 115: 112143.
  50. Alejandro EU, Mamerto TP, Chung G, Villavieja A, Gaus NL, Morgan E, et al. Gestational diabetes mellitus: a harbinger of the vicious cycle of diabetes. Int J Mol Sci 2020; 21(14): 5003.
  51. Lookzadeh MH, Alipour MR, Vakili Zarch A ES. Prevalence of hypertrophic cardiomyopathy in neonates of diabetic mothers: a six-month follow-up study. World J Peri Neonatol 2022; 5(2): 58–64.
  52. Lookzadeh MH, Alipour MR, Vakili-Zarch A, Ekraminasab S. Prevalence of Congenital Heart Diseases in Neonates of Diabetic Mothers: A Cross Sectional Study in Yazd. World J Peri Neonatol 2022; 5(1): 24–9.
  53. Zakaria H, Abusanana S, Mussa BM, Al Dhaheri AS, Stojanovska L, Mohamad MN, et al. The Role of lifestyle interventions in the prevention and treatment of gestational diabetes Mellitus. Medicina (Kaunas) 2023; 59(2): 287.
  54. Daneshmand SS, Stortz S, Morrisey R, Faksh A. Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes. Diabetes Spectr 2019; 32(4): 317–23.
  55. Güldner L, Greffin K, Muehlan H, Stubert J. Assessment of quality of life in gestational diabetes mellitus care-study protocol of the GDM-QOL project. Healthc (Basel, Switzerland). 2023; 12(1): 1.
World Journal of Peri and Neonatology
Volume 7, Issue 1
December 2024
Pages 35-44

Files

History

  • Receive Date: 28 December 2024
  • Accept Date: 28 December 2024

Share

How to cite

Statistics