心率变异性在妊娠期糖尿病孕妇心身疲劳评估中的应用进展与展望

Application Progress of Heart Rate Variability in Psychosomatic Fatigue Assessment of Pregnant Women with Gestational Diabetes and Prospects

摘要: GDM患病率在全球多地持续上升，临床管理负担随之加重。GDM孕妇普遍报告明显的疲劳感，且多伴随情绪低落和睡眠问题，这不仅影响生活质量，也降低了血糖监测和饮食控制的依从性，最终可能危及妊娠结局。HRV作为一种无创检测手段，可客观反映GDM孕妇的自主神经功能状态，且已有证据显示其与压力、抑郁等心身指标存在关联，这为其在心身健康评估中的潜在应用提供了线索。目前已有证据显示，GDM孕妇在应激条件下迷走神经张力下降，且HRV指标与压力、抑郁评分显著相关——尽管疲劳常与压力、抑郁共存，但这些心理变量与疲劳之间的具体关联仍缺乏直接验证。现有结论多依赖间接证据，临床适用性有待大样本纵向研究检验。孕周、血糖波动和昼夜节律等因素对HRV的干扰也不容忽视。未来研究应优先确立GDM孕妇的HRV测量规范，并通过前瞻性随访明确HRV动态变化与疲劳发展的对应关系，为临床干预提供实证支持。

Abstract: Gestational diabetes mellitus (GDM) is becoming more common worldwide, and its implications for perinatal care are increasingly difficult to ignore. Women with GDM frequently report fatigue, low mood, and poor sleep, which undermine their quality of life and adherence to glucose monitoring and dietary control. GDM is not only associated with adverse perinatal outcomes but also with an increased risk of metabolic disorders in offspring and potential impacts on fetal cardiac structure and autonomic nervous system development. Heart rate variability (HRV), a non-invasive index of autonomic function, can objectively reflect autonomic nervous system status in this population, and existing evidence suggests its associations with psychosomatic indicators such as stress and depression, providing a rationale for further exploration of its potential role in psychosomatic health assessment. Several studies have reported autonomic dysregulation in GDM, particularly reduced vagal tone during stress, and significant correlations between HRV parameters and psychological measures such as perceived stress and depression. Although fatigue often coexists with stress and depression, the specific association between these psychological variables and fatigue has not been directly validated in GDM populations. Most current conclusions rely on indirect evidence, and clinical applicability needs to be examined in large-scale longitudinal studies. Importantly, gestational age, glycemic variability, and circadian rhythms can confound HRV readings and should be accounted for in study design and data interpretation. Future research should prioritize standardised HRV measurement protocols for pregnant women with GDM and adopt prospective designs to track the dynamic relationship between HRV changes and fatigue progression, with the goal of building a foundation for more individualised care.