Department of Obstetrics & Gynaecology, University of British Columbia, Rm 590 828 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.
Departments of Psychiatry, University of British Columbia (UBC), 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
BMC Pregnancy Childbirth. 2022 Aug 31;22(1):670. doi: 10.1186/s12884-022-05002-5.
Antenatal depression and anxiety are highly prevalent conditions that have been associated with increased risk for myriad adverse outcomes. Current literature exploring the connection between antenatal mental health and gestational diabetes mellitus (GDM) is limited, presenting conflicting evidence. We sought to evaluate the association between antenatal depression/anxiety (DEP-ANX) and GDM using population-based, administrative data, accounting for aspects of preconception mental health.
In this population-based retrospective cohort study, we included all singleton births in British Columbia, Canada from April 1, 2000, to December 31, 2014. We identified instances of DEP-ANX from outpatient and inpatient records that included relevant diagnostic codes and stratified our cohort by preconception DEP-ANX persistence. Logistic regression models were run to estimate odds of GDM given antenatal DEP-ANX. Models were adjusted for the birthing person's socio-demographics and pregnancy characteristics. Using an expanded cohort, we ran conditional logistic regression models that matched birthing people to themselves (in a subsequent pregnancy) based on discordance of exposure and outcome.
Out of the 228,144 births included in this study, 43,664 (19.1%) were to birthing people with antenatal health service use for DEP-ANX. There were 4,180 (9.6%) cases of GDM among those antenatal exposure to DEP-ANX compared to 15,102 (8.2%) among those without exposure (SMD 0.049). We observed an unadjusted odds ratio (OR) of 1.19 (95% CI: 1.15 - 1.23) and fully adjusted OR of 1.15 (95% CI: 1.11 - 1.19) overall. Apparent risk for GDM given antenatal DEP-ANX was highest among the no DEP-ANX history stratum, with a fully adjusted OR of 1.24 (95% CI: 1.15 - 1.34). Associations estimated by matched sibling analysis were non-significant (fully adjusted OR 1.19 [95% CI: 0.86 - 1.63]).
Results from this population-based study suggest an association between antenatal DEP-ANX and GDM that varied based on mental health history. Our analysis could suggest that incident cases of DEP-ANX within pregnancy are more closely associated with GDM compared to recurring or chronic cases.
产前抑郁和焦虑是高度普遍的疾病，与众多不良后果的风险增加有关。目前探索产前心理健康与妊娠糖尿病（GDM）之间联系的文献有限，提供的证据相互矛盾。我们试图使用基于人群的行政数据评估产前抑郁/焦虑（DEP-ANX）与 GDM 之间的关系，同时考虑到孕前心理健康的各个方面。
在这项基于人群的回顾性队列研究中，我们纳入了 2000 年 4 月 1 日至 2014 年 12 月 31 日期间不列颠哥伦比亚省的所有单胎分娩。我们从门诊和住院记录中确定了 DEP-ANX 的病例，这些记录包括相关的诊断代码，并根据孕前 DEP-ANX 的持续情况对队列进行分层。我们使用逻辑回归模型估计了产前 DEP-ANX 与 GDM 的比值比（OR）。模型调整了产妇的社会人口统计学特征和妊娠特征。在一个扩大的队列中，我们基于暴露和结果的不一致，对产妇进行了自身配对（在随后的妊娠中）的条件逻辑回归模型分析。
在这项研究中，纳入的 228144 例分娩中，有 43664 例（19.1%）的产妇产前接受过 DEP-ANX 的健康服务。在有产前 DEP-ANX 暴露的人群中，有 4180 例（9.6%）发生了 GDM，而在无暴露的人群中，有 15102 例（8.2%）（SMD 0.049）。我们观察到未调整的比值比（OR）为 1.19（95%CI：1.15-1.23），完全调整的 OR 为 1.15（95%CI：1.11-1.19）。在没有 DEP-ANX 病史的人群中，产前 DEP-ANX 与 GDM 的风险最高，完全调整后的 OR 为 1.24（95%CI：1.15-1.34）。匹配同胞分析估计的关联无统计学意义（完全调整后的 OR 为 1.19[95%CI：0.86-1.63]）。
这项基于人群的研究结果表明，产前 DEP-ANX 与 GDM 之间存在关联，这种关联因心理健康史而异。我们的分析表明，妊娠期间新发生的 DEP-ANX 病例与 GDM 的相关性可能比反复发作或慢性病例更为密切。
