Žutić Maja, Matijaš Marijana, Štefulj Jasminka, Brekalo Maja, Nakić Radoš Sandra
University Department of Psychology, Catholic University of Croatia, Ilica 244, Zagreb, 10000, Croatia.
University of Amsterdam, Amsterdam Business School, Amsterdam, Netherlands.
BMC Pregnancy Childbirth. 2024 Dec 19;24(1):821. doi: 10.1186/s12884-024-07046-1.
Gestational diabetes mellitus (GDM) and peripartum depression (PPD) are increasing global health issues with potentially long-lasting adverse outcomes. While limited studies suggest a bidirectional relationship between GDM and PPD, most research has been cross-sectional and focused on one direction of the relationship, primarily if GDM predicts postpartum depression. The interplay between antenatal depression and GDM is less explored, with a critical lack of prospective bidirectional studies. This longitudinal study aimed to investigate the bidirectional relationship between GDM and PPD in a total sample and according to different pre-pregnancy body mass index (BMI) categories. Specifically, we examined whether antenatal depression symptoms predict a subsequent GDM diagnosis and whether GDM predicts subsequent postpartum depression symptoms.
A three-wave online longitudinal study included 360 women who were followed from the second trimester (20-28 weeks, T1) through the third trimester (32-42 weeks, T2), and into the postpartum period (6-20 weeks after birth, T3). Participants completed the General Data Questionnaire, one item about the diagnosis of GDM, and the Edinburgh Postnatal Depression Scale (EPDS). The sample was stratified according to pre-pregnancy BMI into normal-weight (N = 247) and overweight/obese (N = 113) subgroups. Women with type I and II diabetes, GDM at T1, and underweight BMI were excluded.
In the total sample, antenatal depression symptoms predicted GDM, whereas GDM did not predict postpartum depression symptoms. A bidirectional relationship was observed in normal-weight women, where antenatal depression symptoms predicted subsequent GDM diagnosis, and GDM diagnosis predicted postpartum depression symptoms. In contrast, no associations were found in either direction in the overweight/obese subgroup.
This study provides evidence of a bidirectional relationship between GDM and PPD only in women with normal body weight before pregnancy. The results highlight the complexity of the relationship between peripartum mental and metabolic health, that is dependent on pre-pregnancy BMI. Clinicians should be aware that normal-weight women may have a unique sensitivity to the bidirectional interplay between GDM and PPD. Pregnant women should be closely monitored for both mental and metabolic health issues and targeted for prevention programs to reduce the risks and burdens associated with both conditions.
妊娠期糖尿病（GDM）和产后抑郁症（PPD）是日益严重的全球性健康问题，可能会产生长期不良后果。虽然有限的研究表明GDM和PPD之间存在双向关系，但大多数研究都是横断面研究，且侧重于关系的一个方向，主要是GDM是否预测产后抑郁症。产前抑郁症与GDM之间的相互作用较少被探讨，严重缺乏前瞻性双向研究。这项纵向研究旨在调查总样本中以及根据不同孕前体重指数（BMI）类别划分的GDM与PPD之间的双向关系。具体而言，我们研究了产前抑郁症状是否能预测随后的GDM诊断，以及GDM是否能预测随后的产后抑郁症状。
一项三波在线纵向研究纳入了360名女性，她们从孕中期（20 - 28周，T1）开始随访至孕晚期（32 - 42周，T2），并进入产后阶段（出生后6 - 20周，T3）。参与者完成了一般数据问卷、一项关于GDM诊断的问题，以及爱丁堡产后抑郁量表（EPDS）。样本根据孕前BMI分为正常体重（N = 247）和超重/肥胖（N = 113）亚组。排除患有I型和II型糖尿病、T1期患有GDM以及体重过轻的BMI的女性。
在总样本中，产前抑郁症状可预测GDM，而GDM不能预测产后抑郁症状。在正常体重女性中观察到双向关系，产前抑郁症状可预测随后的GDM诊断，而GDM诊断可预测产后抑郁症状。相比之下，超重/肥胖亚组在两个方向上均未发现关联。
本研究仅在孕前体重正常的女性中提供了GDM与PPD之间双向关系的证据。结果突出了围产期心理和代谢健康之间关系的复杂性，这取决于孕前BMI。临床医生应意识到，正常体重的女性可能对GDM与PPD之间的双向相互作用具有独特的敏感性。应对孕妇的心理和代谢健康问题进行密切监测，并针对预防项目，以降低与这两种情况相关的风险和负担。
