The association between gestational diabetes mellitus and postpartum depressive symptomatology: A prospective cohort study

Ruohomäki, Aleksi; Toffol, Elena; Upadhyaya, Subina; Keski‐Nisula, Leea; Pekkanen, Juha; Lampi, Jussi; Voutilainen, Sari; Tuomainen, Tomi‐Pekka; Heinonen, Seppo; Kumpulainen, Kirsti; Pasanen, Markku; Lehto, Soili M.

doi:10.1016/j.jad.2018.08.070

Cited by 46 publications

(30 citation statements)

References 37 publications

(48 reference statements)

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“…As a result, without continued psychosocial support from health services and family in the postpartum period, women feel abandoned and in limbo, which hinders their ability to maintain health behaviour changes. Finnish and American studies have found a significant association between GDM and postnatal depression using the validated Edinburgh Postnatal Depression Scale [11,49]. Only one woman in our study reported having postnatal depression following the GDM pregnancy and similar studies from LMIC are still lacking.…”

Section: Experience Of Gdm Deliverycontrasting

confidence: 64%

“…Interestingly, women with GDM in an Italian study reportedly experienced a better quality of life, compared to pregnant women without GDM [ 7 ] as a result of the improved health behaviours. Considering that among low-income women in South Africa, the experience of at least one stressful event can impact on maternal mental health [ 25 ], risk surveillance for mental health disorders, close monitoring and tailored programmes to reduce perceived emotional distress may have benefits for the overall well-being of women with GDM [ 10 , 11 , 16 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…GDM may also have a negative impact on women's mental wellbeing, functioning and quality of life [6][7][8][9][10]. The sparse literature on GDM and mental health suggests that the diagnosis of GDM is a risk factor for anxiety and stress during pregnancy [11][12][13][14], antenatal [15] and postpartum depression [16,17], with potentially negative effects on treatment adherence [8,9,18]. The perceived stress of effectively managing GDM through lifestyle change coupled with the fear of failure to achieve glycaemic control may trigger depressive symptoms [19].…”

Section: Introductionmentioning

confidence: 99%

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Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

et al. 2020

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Background The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being. Methods Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach. Results Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends. Conclusions The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.

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Section: Experience Of Gdm Deliverycontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

et al. 2020

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“…Gestational weight gain and Caesarean delivery, both complications of GDM, were particularly strongly associated with postpartum depressive symptoms , suggesting that increases in body weight may be an important mediator in those cases where GDM does predate depressive symptoms. One study did report an association between GDM and postpartum depression that was not explained by Caesarean delivery, although gestational weight gain was not measured in this study .…”

Section: Introductionmentioning

confidence: 80%

Depression precedes, but does not follow, gestational diabetes

Clark

Rasgon

Reed

et al. 2018

Acta Psychiatr Scand

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Objectives To determine whether past history of depression is associated with increased rates of gestational diabetes, and whether history of gestational diabetes is associated with increased rates of postpartum depression. Research design Data for this case–control study consisted of de‐identified chart records for 1439 women who received pregnancy care at a large university hospital between 1998 and 2017. Results A history of depression prior to pregnancy was associated with gestational diabetes requiring insulin, although not with subtler degrees of gestational hyperglycemia. Diabetes in pregnancy was not associated with an increased risk of postpartum depression. Trauma history was associated with both impaired glucose tolerance in pregnancy and postpartum depression. Conclusions Past episodes of depression increase risk for the most severe form of gestational diabetes; however, gestational diabetes does not contribute significantly to risk for postpartum depression. This suggests a unidirectional association, unlike the bidirectional association of diabetes with depression among the general population. History of trauma increases risk for both gestational hyperglycemia and postpartum depression, suggesting important health effects of trauma that may differ measurably from those associated with depression.

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“…Antenatal events and social circumstances, such as disease during pregnancy, family dissatisfaction or social isolation, have also been identi ed as risk factors for postnatal depression [11,20]. Maternal depressive symptoms and events in the antenatal period are strongly associated with postnatal depressive symptoms and numerous adverse perinatal outcomes including preterm delivery and low birth weight [19,[21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Stratification of Antenatal Indicators to Guide Population-Based Programs in Perinatal Depression

Eastwood

Wang

Khanlari

et al. 2020

Preprint

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Background: There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. Methods: This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroups differences in antenatal and postnatal depressive symptoms were then assessed, as measured by Edinburgh Postnatal Depression Scale scores recorded at antenatal booking and early postnatal assessments, respectively.Results: Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported ‘local’ women who speak English as their primary language (Group L), another of socially supported ‘migrant’ women who speak a language other than English as their primary language (Group M), another of socially stressed ‘local’ women who speak English as their primary language (Group Ls), and socially stressed ‘migrant’ women who speak a language other than English as their primary language (Group Ms). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while Ms group was over five times more likely, to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms respectively). Conclusions: This study demonstrates that it is possible to stratify pregnant women into subpopulations using their demographic and psychosocial characteristics, to identify those at greatest risk of suboptimal mental health in the antenatal and postnatal periods. The application of empirical subgrouping analysis permits an informed approach to targeted resource allocation for optimising perinatal maternal wellbeing.

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The association between gestational diabetes mellitus and postpartum depressive symptomatology: A prospective cohort study

Abstract: Women with GDM may be at increased risk of PPDS. Future studies should investigate whether these women would benefit from a closer follow-up and possible supportive interventions during pregnancy and the postpartum period to avoid PPDS.

Cited by 46 publications

References 37 publications

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

Depression precedes, but does not follow, gestational diabetes

Psychosocial Stratification of Antenatal Indicators to Guide Population-Based Programs in Perinatal Depression

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