Pregnancy Hyperglycaemia and Risk of Prenatal and Postpartum Depressive Symptoms

Huang, Tianyi; Rifas‐Shiman, Sheryl L.; Ertel, Karen A.; Rich‐Edwards, Janet W.; Kleinman, Ken; Gillman, Matthew W.; Oken, Emily; James‐Todd, Tamarra

doi:10.1111/ppe.12199

Cited by 51 publications

(59 citation statements)

References 37 publications

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“…Our findings in a low-risk, diverse, US sample confirm those of a prior study from Iran [15]. Interestingly, other studies of the association between GDM and postpartum depression have been null, but these studies either assessed depression much later, at 6 months postpartum [12], or used a self-report of depression [13], unlike our study, which used a validated measure of depressive symptoms at 6 weeks postpartum.…”

Section: Discussionsupporting

confidence: 82%

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A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period

et al. 2016

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Aims/hypothesis Depression and glucose intolerance commonly co-occur among non-pregnant individuals; however, the temporal relationship between gestational diabetes (GDM) and depression during pregnancy and the postpartum period is less understood. Our objective was to assess longitudinal associations between depression early in pregnancy and GDM risk, as well as GDM and subsequent risk of postpartum depression. Methods Data came from the prospective National Institute of Child Health and Human Development Fetal Growth Studies-Singleton cohort (2009–2013), and had been collected at 12 US clinical centres. Pregnant women without psychiatric disorders, diabetes or other chronic conditions before pregnancy were followed throughout pregnancy (n=2477). Only women with GDM and matched controls were followed up at 6 weeks postpartum (n=162). GDM was ascertained by a review of the medical records. Depression was assessed in the first (8–13 gestational weeks) and second (16–22 weeks) trimesters and at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale. Postpartum depression was defined as a depressive symptom score ≥10 or antidepressant medicine use after delivery. RR and 95% CI we adjusted for pre-pregnancy BMI and other risk factors. GDM was considered to be the outcome for the first set of analyses, with depression in the first and second trimesters as the exposures. Postpartum depression was considered as the outcome for the second set of analyses, with GDM as the exposure. Results Overall, comparing the highest and lowest quartiles of first-trimester depression scores, the scores from the highest quartile were associated with a significant twofold (95% CI 1.06, 3.78) increased risk of GDM, but this was attenuated to 1.72-fold (95% CI 0.92, 3.23) after adjustment; the second-trimester results were similar. The risk was stronger and significant in both trimesters among non-obese women (p for trend 0.02 and 0.01, respectively), but null for obese women. Women with persistently high depression scores in both trimesters had the greatest risk of GDM (highest vs lowest quartile in both trimesters: adjusted RR 3.21, 95% CI 1.00–10.28). GDM was associated with an adjusted 4.62-fold (95% CI 1.26, 16.98) increased risk of subsequent postpartum depression. Conclusions/interpretation This prospective study demonstrates a modest association between depressive symptoms early in pregnancy and an increased risk of incident GDM, as well as between GDM and subsequent postpartum depression risk, highlighting pregnancy and the postpartum period as an important susceptible time window during the life course for the interplay between depression and glucose intolerance phenotypes. GDM risk associated with elevated depressive symptoms was particularly high among non-obese women and women with symptoms persisting across the first two trimesters of pregnancy.

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Section: Discussionsupporting

confidence: 82%

“…There has also been conflicting evidence on whether GDM is a risk factor for postpartum depression. Of the studies that have prospectively examined this association, the findings have either been conflicting [12–16] or have not distinguished between GDM and pre-existing type 2 diabetes [16]. …”

Section: Introductionmentioning

confidence: 99%

A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period

et al. 2016

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“…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].…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, 11 studies focussed on postpartum depression, most commonly measured within the first 3 mo[20,21,23,25,27,29,33,47,52,62,63]. There were nine studies that measured depression during both pregnancy and postpartum[34,35,38,39,42,44,46,49,65] and five studies that classified participants based on a history of pre-pregnancy depression[28,32,50,56,60]. …”

Section: Resultsmentioning

confidence: 99%

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Relationship between depression and diabetes in pregnancy: A systematic review

Ross

Falhammar

Chen

et al. 2016

WJD

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AIMTo systematically review the literature on women with both diabetes in pregnancy (DIP) and depression during or after pregnancy.METHODSIn this systematic literature review, PubMed/MEDLINE and EMBASE were searched (13 November 2015) using terms for diabetes (type 1, type 2, or gestational), depression, and pregnancy (no language or date restrictions). Publications that reported on women who had both DIP (any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance.RESULTSOf 1189 articles identified, 48 articles describing women with both DIP and depression were included (sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies (mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP (any type) and depression in general populations of pregnant women ranged from 0% to 1.6% (median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80% (median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression.CONCLUSIONGiven the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.

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PROTOCOL: Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low and middle‐income countries: A systematic review

Kang

John

Bisht

et al. 2020

Campbell Systematic Reviews

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Postpartum Depression (PPD) is highly prevalent among women in low and middle income countries (LMICs). World Heath Organization has recognised interpersonal Psychotherapy (IPT) as the first line treatment for the postpartum depression. The primary aim of this review is to evaluate the effectiveness of IPT alone or in combination with pharmacotherapy or other psychosocial therapies for treating depressive symptoms in women with postpartum depression. The generated evidence from this review will help to inform policies in relation to the treatment of postpartum depression in LMICs.

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Pregnancy Hyperglycaemia and Risk of Prenatal and Postpartum Depressive Symptoms

Cited by 51 publications

References 37 publications

A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period

A longitudinal study of depression and gestational diabetes in pregnancy and the postpartum period

Relationship between depression and diabetes in pregnancy: A systematic review

PROTOCOL: Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low and middle‐income countries: A systematic review

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