Symptoms of Posttraumatic Stress Disorder are Associated with Altered Glucose Parameters in Early and Late Gestation

 

 Buy Article Permissions and Reprints

Abstract

Objective Posttraumatic stress disorder (PTSD) is associated with increased risk for insulin resistance and the development of diabetes outside of pregnancy. In pregnancy, emerging evidence suggests that PTSD is associated with increased risk for gestational diabetes; however, it is not yet known how PTSD is associated with disruptions in glucose processing across gestation. Therefore, the aim of the current study was to test associations between PTSD symptoms and glucose parameters in early and late gestation among pregnant people without a history of pregestational diabetes.

Study Design Two 34 participants were included in these analyses. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5) in early gestation. Fasting blood samples were collected at approximately 12 and 32 gestational weeks and were used to calculate β-cell function and insulin sensitivity.

Results Participants were 31 years old (standard deviation [SD] = 6) with body mass index (BMI) of 36 kg/m² (SD = 7) at enrollment, 26% reported their ethnicity as Hispanic, 62% reported their race as White, 17% Black, 2% Asian, 3% Native American, 9% more than one race, and 11% unknown/not reported. Hierarchical linear regression analyses revealed that, after adjusting for several covariates including maternal age, race, ethnicity, BMI, apnea hypopnea index, and depressive symptoms, PTSD symptoms were positively associated with β-cell function in early (β = 0.230, p = 0.016) and late gestation (β = 0.238, p = 0.037).

Conclusion Higher PTSD symptoms were associated with greater insulin secretion over pregnancy in this sample. More research is needed to replicate these findings and evaluate the effects of treatment of PTSD on mitigating the risk for gestational diabetes.

Key Points

• We examined associations among symptoms of PTSD and glucose parameters over pregnancy.

• Symptoms of PTSD were positively associated with β-cell function over pregnancy.

• Symptoms of PTSD were not associated with insulin resistance over pregnancy.

Data Availability Statement

The datasets generated during and/or analyzed in the current study are available from the corresponding author upon reasonable request.

Publication History

Received: 13 July 2023

Accepted: 21 July 2023

Article published online:
24 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing, Inc.; 2013
  CrossrefGoogle Scholar
• 2 O'Donnell CJ, Schwartz Longacre L, Cohen BE. et al. Posttraumatic stress disorder and cardiovascular disease: state of the science, knowledge gaps, and research opportunities. JAMA Cardiol 2021; 6 (10) 1207-1216
  CrossrefPubMedGoogle Scholar
• 3 Vancampfort D, Rosenbaum S, Ward PB. et al. Type 2 diabetes among people with posttraumatic stress disorder: systematic review and meta-analysis. Psychosom Med 2016; 78 (04) 465-473
  CrossrefPubMedGoogle Scholar
• 4 Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ. National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress 2013; 26 (05) 537-547
  CrossrefPubMedGoogle Scholar
• 5 Roberts AL, Agnew-Blais JC, Spiegelman D. et al. Posttraumatic stress disorder and incidence of type 2 diabetes mellitus in a sample of women: a 22-year longitudinal study. JAMA Psychiatry 2015; 72 (03) 203-210
  CrossrefPubMedGoogle Scholar
• 6 LIhua M, Tao Z, Hongbin M, Hui W, Caihong J, Xiaolian J. Metabolic syndrome risk in relation to posttraumatic stress disorder among trauma-exposed civilians in Gansu Province, China. Medicine (Baltimore) 2020; 99 (01) e18614
  CrossrefPubMedGoogle Scholar
• 7 Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (06) 617-627
  CrossrefPubMedGoogle Scholar
• 8 Shaw JG, Asch SM, Katon JG. et al. Post-traumatic stress disorder and antepartum complications: a novel risk factor for gestational diabetes and preeclampsia. Paediatr Perinat Epidemiol 2017; 31 (03) 185-194
  CrossrefPubMedGoogle Scholar
• 9 Blackmore ER, Putnam FW, Pressman EK. et al. The effects of trauma history and prenatal affective symptoms on obstetric outcomes. J Trauma Stress 2016; 29 (03) 245-252
  CrossrefPubMedGoogle Scholar
• 10 Lowe Jr WL, Scholtens DM, Kuang A. et al; HAPO Follow-up Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome follow-up study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42 (03) 372-380
  CrossrefPubMedGoogle Scholar
• 11 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677) 1773-1779
  CrossrefPubMedGoogle Scholar
• 12 Rao MN, Chau A, Madden E. et al. Hyperinsulinemic response to oral glucose challenge in individuals with posttraumatic stress disorder. Psychoneuroendocrinology 2014; 49: 171-181
  CrossrefPubMedGoogle Scholar
• 13 Valsamakis G, Papatheodorou DC, Chalarakis N. et al. In pregnancy increased maternal STAI trait stress score shows decreased insulin sensitivity and increased stress hormones. Psychoneuroendocrinology 2017; 84: 11-16
  CrossrefPubMedGoogle Scholar
• 14 Baeyens L, Hindi S, Sorenson RL, German MS. β-Cell adaptation in pregnancy. Diabetes Obes Metab 2016; 18 (suppl 1, suppl 1): 63-70
  CrossrefPubMedGoogle Scholar
• 15 Song Y, Manson JE, Tinker L. et al. Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women: the Women's Health Initiative Observational Study. Diabetes Care 2007; 30 (07) 1747-1752
  CrossrefPubMedGoogle Scholar
• 16 Izci Balserak B, Pien GW, Prasad B. et al. Obstructive sleep apnea is associated with newly diagnosed gestational diabetes mellitus. Ann Am Thorac Soc 2020; 17 (06) 754-761
  CrossrefPubMedGoogle Scholar
• 17 Sanapo L, Bublitz MH, Bai A. et al. Association between sleep disordered breathing in early pregnancy and glucose metabolism. Sleep 2022; 45 (04) zsab281
  CrossrefPubMedGoogle Scholar
• 18 Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). Accessed December 02, 2022 at: https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp
  PubMedGoogle Scholar
• 19 Bovin MJ, Marx BP, Weathers FW. et al. Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans. Psychol Assess 2016; 28 (11) 1379-1391
  CrossrefPubMedGoogle Scholar
• 20 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 (09) 606-613
  CrossrefPubMedGoogle Scholar
• 21 Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27 (06) 1487-1495
  CrossrefPubMedGoogle Scholar
• 22 Ohkura T, Shiochi H, Fujioka Y. et al. 20/(fasting C-peptide × fasting plasma glucose) is a simple and effective index of insulin resistance in patients with type 2 diabetes mellitus: a preliminary report. Cardiovasc Diabetol 2013; 12: 21
  CrossrefPubMedGoogle Scholar
• 23 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28 (07) 412-419
  CrossrefPubMedGoogle Scholar
• 24 Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care 1998; 21 (12) 2191-2192
  CrossrefPubMedGoogle Scholar
• 25 Zhang H, Zhao D, Shen J, Zhou X, Chen W, Jiang S. Evaluation of oral glucose tolerance test, β-cell function and adverse obstetric outcomes. Biomed Rep 2013; 1 (05) 807-811
  CrossrefPubMedGoogle Scholar
• 26 Farabi SS, Barbour LA, Heiss K, Hirsch NM, Dunn E, Hernandez TL. Obstructive sleep apnea is associated with altered glycemic patterns in pregnant women with obesity. J Clin Endocrinol Metab 2019; 104 (07) 2569-2579
  CrossrefPubMedGoogle Scholar
• 27 Chirakalwasan N, Amnakkittikul S, Wanitcharoenkul E. et al. Continuous positive airway pressure therapy in gestational diabetes with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2018; 14 (03) 327-336
  CrossrefPubMedGoogle Scholar
• 28 Retnakaran R, Ye C, Kramer CK. et al. Evaluation of circulating determinants of beta-cell function in women with and without gestational diabetes. J Clin Endocrinol Metab 2016; 101 (07) 2683-2691
  CrossrefPubMedGoogle Scholar
• 29 Weir GC, Laybutt DR, Kaneto H, Bonner-Weir S, Sharma A. Beta-cell adaptation and decompensation during the progression of diabetes. Diabetes 2001; 50 (Suppl. 01) S154-S159
  CrossrefPubMedGoogle Scholar
• 30 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
  CrossrefPubMedGoogle Scholar
• 31 Berry RB, Gamaldo CE, Harding SM. et al. AASM Scoring Manual Version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med 2015; 11 (11) 1253-1254
  CrossrefPubMedGoogle Scholar
• 32 Das S, Behera MK, Misra S, Baliarsihna AK. Beta-cell function and insulin resistance in pregnancy and their relation to fetal development. Metab Syndr Relat Disord 2010; 8 (01) 25-32
  CrossrefPubMedGoogle Scholar
• 33 Ellerbrock J, Spaanderman B, Drongelen JV. et al. Role of beta cell function and insulin resistance in the development of gestational diabetes mellitus. Nutrients 2022; 14 (12) 2444
  CrossrefPubMedGoogle Scholar
• 34 Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth - United States, 2012-2016. MMWR Morb Mortal Wkly Rep 2018; 67 (43) 1201-1207
  CrossrefPubMedGoogle Scholar
• 35 Bardenheier BH, Elixhauser A, Imperatore G. et al. Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States. Diabetes Care 2013; 36 (05) 1209-1214
  CrossrefPubMedGoogle Scholar
• 36 Bourjeily G, Raker CA, Chalhoub M, Miller MA. Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing. Eur Respir J 2010; 36 (04) 849-855
  CrossrefPubMedGoogle Scholar
• 37 Qiu C, Lawrence W, Gelaye B. et al. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One 2017; 12 (09) e0184966
  CrossrefPubMedGoogle Scholar
• 38 Blessing EM, Reus V, Mellon SH. et al. Biological predictors of insulin resistance associated with posttraumatic stress disorder in young military veterans. Psychoneuroendocrinology 2017; 82: 91-97
  CrossrefPubMedGoogle Scholar
• 39 Bublitz MH, Nillni Y, Nugent NR, Sanapo L, Habr N, Bourjeily G. Posttraumatic stress disorder, diurnal cortisol, and ambulatory blood pressure in early and late pregnancy. J Trauma Stress 2023; 36 (01) 239-246
  CrossrefPubMedGoogle Scholar
• 40 Gavrieli A, Farr OM, Davis CR, Crowell JA, Mantzoros CS. Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: a cross-sectional and prospective study. Metabolism 2015; 64 (11) 1597-1610
  CrossrefPubMedGoogle Scholar
• 41 Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 2005; 14 (02) 106-123
  CrossrefPubMedGoogle Scholar
• 42 Scherrer JF, Salas J, Norman SB. et al. Association between clinically meaningful posttraumatic stress disorder improvement and risk of type 2 diabetes. JAMA Psychiatry 2019; 76 (11) 1159-1166
  CrossrefPubMedGoogle Scholar