Quality of life outcomes in pregnancy and postpartum complicated by hypertensive disorders, gestational diabetes, and preterm birth

Abstract

Health problems can develop during a pregnancy, turning it into a high risk. The aim of this study was to explore the influence of hypertensive disorders, gestational diabetes, and preterm birth as risk factors for health-related quality of life (HRQL) and depressive symptoms during late pregnancy and postpartum. A prospective, longitudinal study was performed with three assessments. Ninety women were recruited in the study including 29 controls. HRQL was measured using the WHO-QOL-BREF questionnaire. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS). Statistical analyses were performed using ANOVA and the chi-square test to explore HRQL and depressive symptoms between three pregnancy risk groups and controls. Women of the preterm group had statistically significant higher depression scores and lower HRQL scores on the physical domain during pregnancy than those without complications. Women with hypertensive disorders showed the second most depressive symptoms. Physical and global HRQL improved and depressive symptoms decreased significantly from late pregnancy and early postpartum period to late postpartum. Pregnant specific health problems, especially the risk for preterm delivery is associated with more depressive symptoms and decreased HRQL in pregnancy. Guidance and communication for these women is important. The counseling should be multi professional to reduce childbirth burdens.

Diabetes and Depression in Pregnancy: Is There an Association?

“…2,4 Moreover, if women with preexisting diabetes or GDM are more likely to be diagnosed with perinatal depression because of a greater number of healthcare visits, this might explain the observed increased odds of depression among women with preexisting diabetes and GDM in the study by Kozhimannil et al 11 With respect to the lack of association between GDM and antenatal depression, our findings were similar to those of three prior smaller studies. [12][13][14] However, evidence from the Australian Carbohydrate Intolerance Study in Pregnant Women, a randomized trial of treatment of hyperglycemia in pregnancy, suggests that treatment of hyperglycemia in pregnancy may improve mood profile, 26 and if women with GDM in our study were screened for depression after beginning treatment for GDM, this could explain our null findings. Therefore, we conducted a sensitivity analysis excluding women screened for depression after 4 months of gestation.…”

“…[11][12][13][14] Three earlier studies found that the mood profile of women with GDM did not differ significantly from that of women without diabetes in pregnancy. [12][13][14] These were relatively small studies that measured antenatal depressive symptoms rather than using diagnostic criteria for major depression.…”

“…[11][12][13][14] Three earlier studies found that the mood profile of women with GDM did not differ significantly from that of women without diabetes in pregnancy. [12][13][14] These were relatively small studies that measured antenatal depressive symptoms rather than using diagnostic criteria for major depression. In contrast, using a large sample of pregnant women enrolled in Medicaid, Kozhimannil et al 11 reported a 2-fold increase in odds of receiving a diagnosis of perinatal depression (defined as depression in the 6 months before delivery and in the first year postpartum) among women with prepregnancy diabetes and GDM compared to women with no diabetes.…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Symptoms are not specific to the HDP, and follow preterm delivery for other indications [520]. Although post-traumatic stress symptoms do not have an impact on infant cognitive or psychomotor development at one year of age, maternal symptoms are amenable to clinical psychological therapy, and earlier referral may abbreviate treatment [523].…”

“…There is growing evidence that women may experience post-traumatic stress disorder up to seven years postpartum [516][517][518][519][520][521][522][523][524], the prevalence of symptoms being highly variable, ranging from the minority to the majority of women, and higher after: maternal hospitalization >7 days, HDP onset/delivery preterm, NICU admission, adverse neonatal outcomes, and uncertainty about the child's longterm health [519]. Symptoms are not specific to the HDP, and follow preterm delivery for other indications [520].…”