Is there an increased risk of perinatal mental disorder in women with gestational diabetes? A systematic review and meta‐analysis

Abstract

Aim Gestational diabetes (GDM) and mental disorder are common perinatal morbidities and are associated with adverse maternal and child outcomes. While there is a relationship between type 2 diabetes and mental disorder, the relationship between GDM and mental disorder has been less studied. We conducted a systematic review and meta‐analysis of the prevalence of mental disorders in women with GDM and their risk for mental disorders compared with women without GDM. Methods Published, peer‐reviewed literature measuring prevalence and/or odds of GDM and perinatal mental disorders was reviewed systematically. Risk of bias was assessed using a checklist. Two independent reviewers were involved. Analyses were grouped by stage of peripartum, i.e. antepartum at the time of GDM diagnosis and after diagnosis, and in the postpartum. Results Sixty‐two studies were included. There was an increased risk of depressive symptoms in the antenatal period around the time of diagnosis of GDM [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.42, 3.05] and in the postnatal period (OR 1.59; 95% CI 1.26, 2.00). Conclusions Given the potential relationship between GDM and perinatal mental disorders, integration of physical and mental healthcare in women experiencing GDM and mental disorders could improve short‐ and long‐term outcomes for women and their children.

Is there an association between anxiety and depression prior to and during pregnancy and gestational diabetes? An analysis of the Born in Bradford cohort

“…The smaller number of studies examining the association between CMD prior to pregnancy and subsequent GDM have provided evidence supporting a relationship ( Beka et al., 2018 ; Bowers et al., 2013 ; Clark et al., 2019 ). Our own meta-analysis of studies during pregnancy and up to one year postpartum, while finding an increased risk of depression in women with GDM during pregnancy, found substantial heterogeneity between studies measuring both symptoms and diagnoses of depression and anxiety ( Wilson et al., 2020 ). Sources of this heterogeneity include variation in measurement of both GDM and mental disorder and also variation in study designs and populations.…”

“…Sources of this heterogeneity include variation in measurement of both GDM and mental disorder and also variation in study designs and populations. Indeed most of the studies, which were observational in their design, we assessed as at high risk of bias in their sampling and/or measurement ( Wilson et al., 2020 ). While in our meta-analysis we conducted a number of sensitivity analyses to try to identify similarities in results within studies of a similar design, for example measurement using diagnostic versus screening tools of mental disorder, no clear trends emerged ( Wilson et al., 2020 ).…”

“…Indeed most of the studies, which were observational in their design, we assessed as at high risk of bias in their sampling and/or measurement ( Wilson et al., 2020 ). While in our meta-analysis we conducted a number of sensitivity analyses to try to identify similarities in results within studies of a similar design, for example measurement using diagnostic versus screening tools of mental disorder, no clear trends emerged ( Wilson et al., 2020 ). We discuss below some of the strengths of this particular study in the Born in Bradford (BiB) cohort which may have resulted in more conservative effect estimates than that seen in other studies.…”

“…The comprehensive glucose profiles provided by systematic testing for GDM with the OGTT in the cohort also allowed for consideration of how the degree of hyperglycaemia may be influenced by CMD. The multi-ethnic composition of the cohort also facilitated analysis of possible ethnic differences in risk, which has been relatively neglected in the GDM and CMD literature to date ( Wilson et al., 2020 ). There were no significant differences in the association between GDM and CMD observed in this study on stratification by ethnicity.…”

“…In a recent systematic review and meta-analysis, we found an increased risk of depression in women with GDM, with the greatest risk during pregnancy, around the time of GDM diagnosis ( Wilson et al., 2020 ). None of the studies were of a UK population and despite an increasing awareness of the influence of preconception mental health on pregnancy outcomes ( Patton et al., 2018 ; Wilson et al., 2018 ) there have been few studies investigating the risk of GDM in women with preconception mental disorders.…”