Mental Health Disorders Subsequent to Gestational Diabetes Mellitus Differ by Race/Ethnicity

Abstract

The incidence of mental health disorders subsequent to GDM was attenuated after adjustment for clinical and socioeconomic factors. Moreover, race/ethnicity influenced this relationship. Further investigation is warranted to clarify potential underlying mechanisms.

Relationship between depression and diabetes in pregnancy: A systematic review

“…Overall, 48 publications were included in this review (Figure 1, Table 1, Table 2, Table 3, Supplementary Table 1). Of these, 30 described prospective observational studies[20,21,23,24,26,27,29-31,34,35,37,38,41,43-45,47-49,51,54,57,58,60-62,65-67], 15 described retrospective observational studies[22,25,28,32,39,40,42,46,50,53,55,56,59,63,64], and three described randomized controlled trials (RCTs)[33,36,52], two of which reported only baseline data[36,52]. Two publications described the same study, but reported different subgroup analyses[23,29].…”

“…A total of 28 studies included only women with GDM[20,23,26-29,31,33,35-38,40,43-45,47-49,51-53,57,58,60,61,63,64], 14 included women with either GDM or pre-existing diabetes (although the type was not always reported)[22,25,39,41,42,46,50,54-56,59,62,65,66], one included women with either GDM or type 1 diabetes[34], one included only women with type 1 diabetes[67], one included only women with pre-existing diabetes (type not reported)[30] and three did not report the type of diabetes[21,24,32] (Tables 1-3, Supplementary Table 1). Sample sizes ranged from 36[65] to more than 32 million in a retrospective analysis of a nationwide hospital database[22] (Tables 1-3, Supplementary Table 1).…”

“…Further, most studies defined depression using measures of depressive symptoms rather than more rigorous clinical diagnosis tools. Among those that did use clinical diagnosis tools, most were retrospective, including six national, state/provincial, or veterans’ health database studies[32,40,50,55,56,64], two claims registry studies[39,46], and three hospital records review studies[22,28,63]. Although these studies were large, their retrospective nature was an inherent limitation.…”

“…However, only 3 of 186 women were subsequently diagnosed with GDM, and the publication did not report whether these women had depression, another psychiatric disorder, or no psychiatric disorder. Eleven retrospective studies used International Classification of Diseases (ICD) codes[68] in medical records to classify participants as having current or a history of depression[22,28,32,39,40,46,50,55,56,63,64]. One of these retrospective studies also included diagnoses based on the DSM-IV[50].…”

“…Similarly, a maternal and infant database study ( n = 1057647) reported that GDM was significantly associated with increased risk of depression at the time of hospital discharge after delivery [adjusted OR (95%CI): 1.44 (1.26-1.65)][64]. A hospital records review ( n = 18192 pregnancies) reported that GDM was significantly associated with increased risk of postpartum depression after adjustment for age, pre-eclampsia, and preterm birth [OR (95%CI): 1.46 (1.16-1.83); P = 0.001], but not after adjustment for other clinical and socioeconomic factors [OR (95%CI): 1.29 (0.98-1.70); P = 0.064)[63]. Conversely, another hospital records review ( n = 128295) reported that a history of depression was a risk factor for the development of GDM [OR (95%CI): 1.42 (1.26-1.60)][28].…”