A RECENT study has investigated the intricate relationship between stress levels and glucose levels during fertility treatment. Stress is often associated with metabolic conditions, such as polycystic ovarian syndrome, and fertility treatments themselves can disrupt normal metabolism, primarily through abnormal glucose metabolism. The prospective study, conducted as part of the Environmental and Reproductive Health (EARTH) study at the Massachusetts General Hospital Fertility Center, Boston, USA, aimed to understand the correlation between perceived stress and pregnancy glucose levels in the period immediately before conception.
Participants were stratified by socioeconomic status and mode of conception before completing a Perceived Stress Scale 4 (PSS-4) survey to measure their mental stress levels before conception. Subsequently, blood glucose screening was conducted during late pregnancy, assessing gestational diabetes after a 50 g glucose load. Environmental and lifestyle factors, including lack of physical activity, pollution, and poor diet quality, were considered potential contributors to abnormal glucose homeostasis during the preconception window.
Overall, a total of 300 pregnancies were included in the study, with 60% achieved through in vitro fertilisation, and 16% through intrauterine insemination (IUI). The median PSS-4 score was 5, and the mean was glucose level 119 mg/dL 1 hour after 50 g glucose load. Hyperglycaemia, defined as 140 mg/dL or higher, was present in one-fifth of the participants, who also reported a median PSS-4 of 6. Results suggest that as stress levels increased, mean glucose levels also rose across tertiles, increasing from 115 mg/dL in the first tertile to 124 mg/dL in the third. Furthermore, the risk of hyperglycaemia increased by 4% and 13% in the second and third tertiles of stress respectively, compared to the first tertile.
Further analysis revealed that females with at least a college-level degree, and those with higher education exhibited a stronger link between stress and abnormal glucose levels during pregnancy. The findings also suggested a potential association between stress and abnormal glucose levels in females who conceived via IUI. However, the study acknowledges the need for validation, due to the low number of such cases.
Overall, the study emphasises that higher preconception psychological stress is linked to elevated pregnancy blood glucose levels, and a greater likelihood of abnormal glucose levels during pregnancy. While the association with IUI needs further validation, the study indicated that higher educational levels and income may be risk factors for gestational hyperglycaemia. The results underscore the importance of considering preconception stress in understanding cardiovascular health during pregnancy, calling for future studies to include diverse communities to validate and generalise these findings.
