Associations of adverse maternal experiences and diabetes on postnatal maternal depression and child social-emotional outcomes in a South African community cohort

Abstract

Previous literature has identified associations between diabetes during pregnancy and postnatal maternal depression. Both maternal conditions are associated with adverse consequences on childhood development. Despite an especially high prevalence of diabetes during pregnancy and maternal postnatal depression in low- and middle-income countries, related research predominates in high-income countries. In a South African cohort with or without diabetes, we investigated associations between adverse maternal experiences with postnatal maternal depression and child social-emotional outcomes. South African mother-child dyads were recruited from the Bishop Lavis community in Cape Town. Participants consisted of 82 mother-child dyads (53 women had GDM or type 2 diabetes). At 14–20 months postpartum, maternal self-report questionnaires were administered to assess household socioeconomic status, food insecurity, maternal depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)), maternal trauma (Life Events Checklist), and child social-emotional development (Brief Infant Toddler Social Emotional Assessment, Ages and Stages Questionnaires: Social-Emotional, Second Edition). Lower educational attainment, lower household income, food insecurity, living without a partner, and having experienced physical assault were each associated with postnatal maternal depressive symptoms and clinical maternal depression (EPDS ≥ 13). Maternal postnatal depression, lower maternal educational attainment, lower household income, household food insecurity, and living in a single-parent household were each associated with child social-emotional problems. Stratified analyses revealed maternal experiences (education, income, food insecurity, trauma) were associated with postnatal maternal depressive symptoms and child social-emotional problems only among dyads with in utero exposure to diabetes. Women with pre-existing diabetes or gestational diabetes in LMIC settings should be screened for health related social needs to reduce the prevalence of depression and to promote child social-emotional development.

Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study

“…However, to our knowledge, this is the first study to report perinatal maternal depressive symptoms as a moderator in the association between GDM and child autism behaviors. Our findings are in part supported by a study that reported an association of adverse maternal experiences including prior experiences of trauma with postnatal maternal depressive symptoms and child social‐emotional problems, only among mothers with diabetes during pregnancy (Rayport et al, 2022). ASD is estimated to be 40%–80% heritable; however, both genetic and non‐genetic factors can modulate the penetrance of autism risk genes, which results in a highly heterogeneous ASD phenotype (Rylaarsdam & Guemez‐Gamboa, 2019).…”

Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers

“…As well as research using structured tools there are previous studies which examine exposures associated with single features of social communication development in toddlerhood. Multiple factors including less responsive or less effective maternal parenting styles 34 , 35 , greater maternal depression and experience of trauma 36 and a lower quality home environment 37 have been correlated with less favourable social communication development in toddlerhood.…”