Depression in Early Pregnancy Linked to Gestational Diabetes
Gestational diabetes is a form of diabetes (high blood sugar level) occurring only in pregnancy, which if untreated may cause serious health problems for mother and infant. According to a study published online in Diabetologia (19 September 2016), a two-way link has been identified between depression and gestational diabetes.
The authors analyzed pregnancy records from the NICHD Fetal Growth Studies-Singleton Cohort, which tracked the progress of thousands of pregnancies, to understand the patterns of fetal growth. The study enrolled 2,334 non-obese and 468 obese women in weeks eight to 13 of pregnancy. The women responded to questionnaires on symptoms of depression when they enrolled in the study, again between the 16th and 22nd week of pregnancy, and then six weeks after giving birth. The authors also reviewed the women’s records to identify who had developed gestational diabetes.
According to an analysis of pregnancy records, women who reported feeling depressed during the first two trimesters of pregnancy were nearly twice as likely to develop gestational diabetes. Persistent depression from the first to second trimester set women at even greater risk for gestational diabetes, and that women who had the highest scores for depression in the first and second trimesters, about 17%, had nearly triple the risk for gestational diabetes when compared to women who had lower depression scores. Conversely, a separate analysis found that women who developed gestational diabetes were more likely to report postpartum depression six weeks after giving birth, compared to a similar group of women who did not develop gestational diabetes. Although obesity is known to increase the risk for gestational diabetes, interestingly, the likelihood of gestational diabetes was higher for non-obese women reporting depression than for obese women with depression. In fact, depression did not appear to increase the risk for gestational diabetes among obese women. In contrast, non-obese women with high depression scores had nearly triple the risk for gestational diabetes than the other women in the study. The authors added that the results suggest it would be a good idea for clinicians to pay particular attention to women with high depression scores when evaluating the risk of gestational diabetes. The authors also found a higher risk for postpartum depression among the women who had gestational diabetes. Of the women who developed gestational diabetes, nearly 15% experienced depressive symptoms after birth, which was more than four times that of women who had not had gestational diabetes.
Currently, the American College of Obstetricians and Gynecologists recommends that physicians screen patients at least once for depression during the perinatal period (22 weeks of pregnancy through 7 days after birth.)
The authors stressed that the study was not able to prove a cause and effect relationship between symptoms of depression and gestational diabetes, but noted that earlier studies have shown that depression is associated with impaired glucose metabolism that may lead to higher blood sugar levels. Similarly, high blood sugar levels may lead to inflammation, hormonal, and other changes that could lead to symptoms of depression.