A Longitudinal Cohort Study Of Gestational Diabetes Mellitus And Perinatal Depression

ObjectivesOur study aimed to determine whether gestational diabetes mellitus（GDM）was associated with perinatal depression（PND）and the trajectories of PND throughout the whole perinatal period and to explore the temporal association between blood glucose and depression.MethodsThis study was nested in the pilot study of an implementation study called the perinatal depression screening and management（PDSM）program that adopting a longitudinal cohort design and enrolling 1 189 women in the first trimester(≤14⁺⁶week)and receiving prenatal care in Ma’anshan Maternal and Child Health Care Center from May-September 2019.Participants were followed to postpartum by up to four times.Data on sociodemographic characteristics and depression were collected using self-developed questionnaires incorporating the Edinburgh Postnatal Depression Scale（EPDS）.Oral glucose tolerance test（OGTT）and fasting plasma glucose（FPG）data were extracted from electronic medical records.Associations between GDM and PND at different time periods were determined by logistic regression.Based on EPDS scores,participants were divided into different trajectories via a latent class growth model（LCGM）,with logistic regression applied to assess the associations between GDM and these trajectories.The path of association between blood glucose and depression in perinatal period over time was estimated with an autoregressive cross-lagged model（ARCLM）.Finally,logistic regression was used to assess the association between GDM and comorbid depression and anxiety in the perinatal period.ResultsIn total,313（30.0%）women were diagnosed with GDM among 1 043 women included in analysis in this study.The detection rates of depression in the first,second,and third trimesters and postpartum period were 17.2%,6.9%,6.8%and 9.0%,respectively and the rate of PND among the whole perinatal period was 26.6%.The detection rates of the comorbid depression and anxiety in the first,second,and third trimesters and the postpartum period were 14.8%,5.4%,4.9%and 6.9%,respectively.Univariate analysis showed that age,prepregnancy BMI,weight gain per week in the second trimester,occupation,conception method,conception season,family history of diabetes,gravidity and parity were factors for GDM and age,prepregnancy BMI,marital status,work status,social status,unexpected pregnancy and drinking were factors of PND.After adjustments for appropriate covariates,the logistic regression analysis of the association between GDM and PND showed that,GDM was not significantly associated with PND at any time point（first trimester:a OR=0.714,95%CI:0.455-1.120;second trimester:a OR=1.211,95%CI:0.636-2.306;third trimester:a OR=0.702,95%CI:0.344-1.433;postpartum period:a OR=0.795,95%CI:0.420-1.507）.Based on EPDS scores throughout the perinatal period,participants were divided into two trajectories:high-down（29.3%）and low-down（70.7%）.GDM had no statistical influence on the trajectory of PND（a OR=1.092,95%CI:0.797-1.497）.The results of path analysis showed that only autoregressive paths of FPG and EPDS were significant(b _EPDSwere 0.460,0.582 and 0.534,respectively;b _FPGwere 0.190,0.414 and 0.151,respectively,P<0.001)and the correlation paths（r were 0.042,-0.035,-0.038 and 0.027,respectively）and cross paths(b _EPDS→FPGwere 0.011,0.048 and 0.017,respectively;b _FPG→EPDSwere-0.030,-0.012 and 0.033,respectively)of the two were not statistically significant（P>0.05）.GDM was not significantly associated with comorbid depression and anxiety in either the first trimester（a OR=0.806,95%CI:0.490-1.328）,second trimester（a OR=1.138,95%CI:0.519-2.498）,third trimester（a OR=0.644,95%CI:0.271-1.533）or postpartum period（a OR=0.602,95%CI:0.269-1.347）.ConclusionsIn conclusion,this longitudinal cohort study found no association between GDM/blood glucose and PND.