Background
Maternal psychosocial stress, including experiences of discrimination, has been linked
to adverse pregnancy outcomes. Perceived discrimination may activate the chronic stress
response, the downstream effects of which include dysregulation of metabolic and immune
systems. The effect of perceived discrimination on the development of gestational
diabetes mellitus, a metabolic disorder of pregnancy, has not been evaluated.
Objective
This study aimed to evaluate the association between perceived maternal discrimination
and incidence of gestational diabetes mellitus.
Study Design
A prospective cohort study of 744 pregnant women was conducted from 2013 to 2015 at
4 sites in the United States. Participants were women who were ≥18 years old with
a singleton pregnancy, <21 weeks pregnant when recruited into the study, and English
speaking without fetal anomalies, progesterone treatment, or corticosteroid use during
pregnancy. Women with pregestational diabetes were excluded from the study. Participants
with a gestational age between 12 0/7 and 20 6/7 weeks completed the Williams Discrimination
Scale. For this analysis, Williams Discrimination Scale scores were dichotomized at
the 75th percentile. We estimated the association between scoring in the top quartile
of the Williams Discrimination Scale and developing gestational diabetes mellitus
using logistic regression. As obesity is an independent risk factor for developing
gestational diabetes mellitus, we also used mediation methods to determine the proportion
of the association mediated by prepregnancy obesity (body mass index, ≥30 kg/m2). Models were adjusted for maternal age, income, parity, race and ethnicity, and
study site.
Results
Among the 595 eligible subjects, 368 (61.9%) were white, 99 (16.6%) black, and 93
(15.6%) Hispanic. The mean body mass index was 27.4 kg/m2 (standard deviation, 7.1 kg/m2), and 50 subjects (8.4%) developed gestational diabetes mellitus. Women with gestational
diabetes mellitus were significantly more likely to be older, to be multiparous, and
to have a lower income. Scoring in the top quartile of the Williams Discrimination
Scale was associated with a significantly increased risk of developing gestational
diabetes mellitus (12.8% vs 7.0%; adjusted odds ratio, 2.11; 95% confidence interval,
1.03–4.22). Obesity mediated 22.6% of the relationship between the Williams Discrimination
Scale and gestational diabetes mellitus.
Conclusion
Women who perceived greater discrimination had an increased risk of developing gestational
diabetes mellitus. Results from the mediation analysis indicate that more than 20%
of the association between discrimination and gestational diabetes mellitus operates
via a pathway that includes obesity. Future studies should examine this and other
mechanistic pathways that may underlie these associations.
Key words
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Article Info
Publication History
Published online: September 12, 2020
Accepted:
September 1,
2020
Received in revised form:
August 14,
2020
Received:
April 16,
2020
Footnotes
The authors report no conflict of interest.
This study was funded in part by grant numbers HHSN275201200007I and HHSN27500005 from the National Children’s Study: Vanguard Study—Task Order 5: Stress and Cortisol Measurement for the National Children’s Study. Principal Investigator: Ann E.B. Borders, MD, MSc, MPH.
Cite this article as: MacGregor C, Freedman A, Keenan-Devlin L, et al. Maternal perceived discrimination and association with gestational diabetes. Am J Obstet Gynecol MFM 2020;2:100222.
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