孕妇发中皮质醇浓度与妊娠中期胰岛素抵抗增加的关系。
Maternal hair cortisol concentrations and its association with increased insulin resistance in midpregnancy.
机构信息
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
Departamento Académico de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Perú; Instituto Nacional Materno Perinatal, Lima, Perú.
出版信息
Ann Epidemiol. 2023 May;81:14-23.e8. doi: 10.1016/j.annepidem.2023.02.011. Epub 2023 Feb 24.
PURPOSE
Stress and elevated maternal glycemia have negative effects on pregnancy. We evaluated the association of hair cortisol concentrations (HCC), a marker of chronic stress, with insulin resistance and gestational diabetes (GDM).
METHODS
In total, 527 women from Lima, Peru, provided a hair sample in the second trimester of their pregnancy to measure HCC using liquid chromatography-tandem mass spectrometry. Each 6 cm of hair captured HCC in early (T1=1-12 weeks) and midpregnancy (T2 = 13-24 weeks). GDM diagnosis was conducted in midpregnancy. Multivariable regression models adjusted for putative risk factorsincluding maternal sociodemographic factors, diabetes history, and hair characteristics, were used to estimate the association of HCC with GDM and various glycemic traits.
RESULTS
GDM was diagnosed in 122 (23%) women. Mean HCC across pregnancy was T1 = 3.7 (±3.4) pg/mg and T2 = 4.8 (±3.4) pg/mg. HCC was associated with increased log-transformed units of fasting insulin (T1 = 0.15 [0.03, 0.27], T2 = 0.17 [0.04, 0.30]), homeostasis model assessment for insulin resistance (T1 = 0.14 [0.01, 0.26], T2 = 0.17 [0.03, 0.30]), and homeostasis model assessment for β-cell function (T1 = 0.20 [0.05, 0.34], T2 = 0.20 [0.04, 0.36]), but not with GDM (T1 = 0.95 [0.63, 1.40], T2 = 1.11 [0.74, 1.67]).
CONCLUSIONS
Elevated maternal HCC was associated with abnormal insulin homeostasis in pregnancy. Dysregulation of the hypothalamic-pituitary-adrenal axis, as reflected by high HCC, may also contribute to insulin resistance syndrome in pregnancy.
目的
压力和母体血糖升高对妊娠有负面影响。我们评估了头发皮质醇浓度（HCC）作为慢性应激标志物与胰岛素抵抗和妊娠糖尿病（GDM）之间的关联。
方法
在秘鲁利马，共有 527 名女性在妊娠中期提供了头发样本，使用液相色谱-串联质谱法测量 HCC。每 6 厘米的头发可捕获妊娠早期（T1=1-12 周）和中期（T2=13-24 周）的 HCC。在妊娠中期进行 GDM 诊断。使用多变量回归模型调整了可能的危险因素，包括孕产妇社会人口学因素、糖尿病史和头发特征，以估计 HCC 与 GDM 和各种血糖特征的关联。
结果
122 名（23%）女性被诊断为 GDM。整个妊娠期间的平均 HCC 为 T1=3.7（±3.4）pg/mg 和 T2=4.8（±3.4）pg/mg。HCC 与空腹胰岛素的对数转换单位增加相关（T1=0.15[0.03，0.27]，T2=0.17[0.04，0.30]）、胰岛素抵抗的稳态模型评估（T1=0.14[0.01，0.26]，T2=0.17[0.03，0.30]）和β细胞功能的稳态模型评估（T1=0.20[0.05，0.34]，T2=0.20[0.04，0.36]），但与 GDM 无关（T1=0.95[0.63，1.40]，T2=1.11[0.74，1.67]）。
结论
母体 HCC 升高与妊娠期间胰岛素稳态异常有关。HCC 升高反映的下丘脑-垂体-肾上腺轴失调也可能导致妊娠期间的胰岛素抵抗综合征。
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