Effect of maternal perceived stress during pregnancy on gestational diabetes mellitus risk: A prospective case-control study Surabhi Mishra a, * , Avinash Shetty b , Chythra R. Rao b , Sathisha Nayak c , Asha Kamath d a Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, 248016, India b Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India c Department of Obstetrics and Gynaecology, Dr. TMA Pai Rotary Hospital, Karkala, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Karnataka, 576104, India d Department of Data Sciences, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India article info Article history: Received 23 August 2019 Received in revised form 20 June 2020 Accepted 22 June 2020 Keywords: Perceived stress Gestational diabetes mellitus Cohen perceived stress scale Oral glucose tolerance test abstract Background and aims: A variety of risk factors have been reported for the development of gestational diabetes mellitus (GDM). But limited review on the role of antenatal perceived stress necessitated the design of the present study to evaluate the association between GDM and perceived stress during pregnancy. Methods: A prospective case-control study was carried out among 100 GDM cases and 273 matched controls, attending regular antenatal clinic at two private hospitals of Karnataka. Data was collected by personal interviews using a standard questionnaire. Perceived stress was assessed using the Cohen 10- item Perceived Stress Scale. Score of 20 was identified as high stress. Statistical Package for the So- cial Sciences version 15 was used for analysis. Results: Exposure rates for high maternal perceived stress among cases during pregnancy were noted. The odds of GDM were 13 folds higher among those with high antenatal stress (20) compared to those with low (<20) (p < 0.001) perceived stress. No correlation between maternal antenatal stress and blood glucose following OGTT was noted. Conclusions: The study identified high perceived stress during pregnancy as a potential risk factor for GDM. © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction Gestational diabetes mellitus (GDM) is defined as the diabetes diagnosed in second and third trimesters of pregnancy [1]. With time, the disease has emerged as a global public health problem [2]. According to International Diabetes Federation (IDF) 2019 Diabetes Atlas, GDM continues to affect one in six births worldwide [3]. It estimates 20.4 million global live births (15.8%) are to women with hyperglycaemia in pregnancy [3]. Among them, 83.6% of adverse perinatal outcomes are still due to GDM, 7.9% are caused by pre- GDM. Remaining 8.5% are due to other diabetes sub-types first diagnosed during pregnancy [3]. In India alone, the disease is complicating nearly four million pregnancies annually, represent- ing large subset of population at high-risk for adverse perinatal morbidity and mortality if addressed inappropriately [2]. Beyond perinatal implications, GDM marks the beginning of a vicious cycle in which diabetes begets more diabetes [4,5], leaving a legacy for both affected mother and her offspring to face impending long- term consequences [6]. Besides diet and other modifiable risk factors, psychological maternal stress has the potential to exacerbate GDM risk inde- pendently [7e9]. The stress of any form stimulates gluconeogenesis by activating hypothalamicepituitaryeadrenal (HPA) axis that mediates production of glucocorticoid and corticotrophin releasing hormones, leading to subsequent hyperglycaemia. This mechanism of stress induced hyperglycaemia, along with reduced insulin sensitivity, intends to supply terminal energy for the urgent needed * Corresponding author. E-mail addresses: surabhimishra42@gmail.com (S. Mishra), avinash.shetty@ manipal.edu (A. Shetty), chythra.raj@manipal.edu (C.R. Rao), sathisha.nayak@ manipal.edu (S. Nayak), asha.kamath@manipal.edu (A. Kamath). Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx https://doi.org/10.1016/j.dsx.2020.06.048 1871-4021/© 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 14 (2020) 1163e1169