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Preconception stress during the infertility process may spell glycemic woes for women during pregnancy, researchers reported.

For women who attended a fertility center, those who self-reported more psychological stress prior to the pregnancy tended to have elevated glucose levels, Lidia Mínguez-Alarcón, PhD, of Harvard T. H. Chan School of Public Health in Boston, and colleagues found.

As shown in the study in the , women who reported the highest levels of psychological distress had on average a 9-point higher glucose level than women in the lowest tertile, which served as the reference group (P for trend=0.007):

• Highest stress tertile: average glucose level 124 mg/dL

• Middle stress tertile: 119 mg/dL

• Lowest stress tertile: 115 mg/dL

This equated to women in the highest and middle stress tertiles having a 13% and 4% higher probability of having an abnormal glucose level than women in the lowest stress tertile, respectively (P trend=0.01).

"Our results highlight the importance of considering preconception as a sensitive window of stress in relation to cardiovascular health during pregnancy," said Mínguez-Alarcón in a statement. "A few ways women can lower their stress levels include being more active, avoiding alcohol and drugs, eating healthy and avoiding isolation."

The study honed in on 398 women (average age 35) who sought fertility care from the Massachusetts General Hospital Fertility Center in Boston from 2004 through 2019. A total of 83% were white and average body mass index was 23.4. Most underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection as their mode of conception, followed by natural conception (25%), and intrauterine insemination (IUI). About half had an unexplained initial infertility diagnosis, followed by a female factor (29%), and male factor (24%).

Blood glucose levels during pregnancy were measured with a 1-hour nonfasting, 50-g glucose load test at late-second/early-third trimester as part of the two-step method using the Carpenter-Coustan criteria for gestational diabetes mellitus screening among women in this study.

Perceived stress was quantified using the short form of the Perceived Stress Scale, which inquired about stress specifically during the prior 3 months. Higher scores on this scale indicated more stress, which were used to create the three tertiles: tertile 1 was a score of 0-3, tertile two was 4-6, and tertile three was a score of 7-14. Women with abnormal gestational glucose levels averaged a perceived stress score of 6 compared with an average score of 5 for women with normal glucose levels.

Looking closer at the mode of conception, researchers found that women who conceived using IUI tended to have a stronger link between stress and abnormal glucose levels. "This may be explained by the fact that IUI treatment has shown less effectiveness as an infertility treatment compared to IVF, so women undergoing IUI may experience more distress compared to those going through IVF," said Mínguez-Alarcón.

Likewise, women with a college degree and a higher income also had a stronger link between these two factors. "It has previously been shown that those with a higher education level experience greater levels of job stress, with stronger associations found in women than in men," Mínguez-Alarcón pointed out. "Given that education level is positively associated with salary, it is possible that this explanation applies to women with higher incomes as well. Professional women are often also responsible for balancing demands in the workplace with household duties and childcare."

The researchers noted to keep in mind that this study was exclusive to women seeking fertility care, which in itself is a stressful situation, and therefore shouldn't be generalized to the greater population. Also, stress levels were self-reported, which are vulnerable to bias.

"Given the scarce literature on preconception stress and pregnancy glucose levels, additional studies are needed to corroborate these findings," the researchers concluded.

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