Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia.
Int J Environ Res Public Health. 2020 May 26;17(11):3767. doi: 10.3390/ijerph17113767.
Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg's tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251-1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205-1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736-2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.
先前的文献报道，妊娠合并糖尿病（DIP）患者发生产前抑郁症的风险增加，但队列研究的结果并不一致。我们进行了系统评价和荟萃分析，以量化队列研究中 DIP 与产前抑郁症风险之间的关联。检索了 Medline、Cinahl 和 PubMed 数据库，以获取研究孕妇患有糖尿病和妊娠期糖尿病及其产前抑郁症风险的研究，这些研究的期刊从创刊到 2019 年 12 月 27 日。我们使用随机效应模型得出汇总估计值，并以汇总相对风险（RR）和置信区间（CI）报告结果。使用漏斗图评估发表偏倚，并使用 Egger 和 Begg 检验进行量化。这项荟萃分析纳入了 10 项研究，涉及 71036 名孕妇。患有妊娠期糖尿病的孕妇发生产前抑郁症的汇总 RR 为 1.430（95%CI：1.251-1.636）。将患有糖尿病和妊娠期糖尿病的孕妇合并在一起，与不患有该疾病的孕妇相比，他们发生产前抑郁症的风险显著增加（RR=1.431，95%CI：1.205-1.699）。相比之下，我们发现妊娠合并糖尿病（RR=1.300，95%CI：0.736-2.297）与发生产前抑郁症的风险之间没有关联。这项研究有一些局限性：首先，在评估抑郁症时，不同的问卷和截断值在研究中被使用。其次，在怀孕前的抑郁症病史方面缺乏数据，这导致了无法通过这项荟萃分析解决的混杂偏倚。第三，数据主要来自西方国家的研究；这是由于来自东方国家的研究不符合我们进行统计分析的纳入标准。与没有这种疾病的孕妇相比，患有妊娠期糖尿病的孕妇发生产前抑郁症的风险增加。因此，对于诊断患有糖尿病和妊娠期糖尿病的孕妇，应更加关注其心理健康状况。
