Trauma and Posttraumatic Stress Disorder as Important Risk Factors for Gestational Metabolic Dysfunction

Abstract

Gestational metabolic diseases adversely impact the health of pregnant persons and their offspring. Pregnant persons of color are impacted disproportionately by gestational metabolic disease, highlighting the need to identify additional risk factors contributing to racial-ethnic pregnancy-related health disparities. Trauma exposure and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiometabolic disorders in nonpregnant persons, making them important factors to consider when identifying contributors to gestational metabolic morbidity and mortality health disparities. Here, we review current literature investigating trauma exposure and posttraumatic stress disorder as psychosocial risk factors for gestational metabolic disorders, inclusive of gestational diabetes, low birth weight and fetal growth restriction, gestational hypertension, and preeclampsia. We also discuss the physiological mechanisms by which trauma and PTSD may contribute to gestational metabolic disorders. Ultimately, understanding the biological underpinnings of how trauma and PTSD, which disproportionately impact people of color, influence risk for gestational metabolic dysfunction is critical to developing therapeutic interventions that reduce complications arising from gestational metabolic disease. KEY POINTS: · Gestational metabolic diseases disproportionately impact the health of pregnant persons of color.. · Trauma and PTSD are associated with increased risk for cardiometabolic disorders in nonpregnant per.. · Trauma and PTSD impact physiological cardiometabolic mechanisms implicated in gestational metabolic..

Fig. 1

Parallel impacts of trauma and PTSD ( A ) and pregnancy ( B ) on physiology. (A) Trauma exposure and PTSD lead to dysregulation of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (ANS) axis. Downstream, dysregulation of the major stress axes leads to an increase in inflammatory markers and dysregulation in metabolic processes such as glucose and insulin production and sensitivity, leptin release and lipogenesis. (B) SNS and HPA axis adaptations during gestation. Normal pregnancy is accompanied by adaptive physiological shifts in both the SNS and HPA axis, including a reduction in HRV and an increase in cortisol and ACTH, respectively. To accommodate increasing fetal energy demands, gestation is also accompanied by hyperglycemia and insulin resistance. To prevent rejection of the growing fetus by the pregnant person's immune system, there is a shift toward an anti-inflammatory state during the second and third trimester of pregnancy. Illustration by Bona Kim; reproduced with permission of ©Emory University. HRV, heart rate variability; PTSD, posttraumatic stress disorder.