Wang Yan, Quan Yunxia
The Sixth Department of Obstetrics, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, Hebei, 050000, China.
Department of Clinical psychology, Shijiazhuang Maternal and Child Health Hospital, Shijiazhuang, Hebei, 050000, China.
BMC Pregnancy Childbirth. 2025 Aug 6;25(1):818. doi: 10.1186/s12884-025-07916-2.
To investigate the incidence and influencing factors of comorbid depression in pregnant women with gestational diabetes mellitus (GDM), analyze their interaction effects, and propose targeted intervention strategies.
A retrospective analysis was conducted on clinical data from 746 pregnant women who underwent regular prenatal examinations at our hospital from March 2022 to March 2024. All participants were screened for GDM using the oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Based on GDM diagnosis, the cohort was divided into GDM and non-GDM groups, with demographic and clinical indicators compared between groups. For GDM patients, the Hamilton Depression Rating Scale-17 (HAMD-17) was used to assess depressive symptoms, categorizing them into a negative screened group (HAMD-17 score > 7) and a positive screened group (HAMD-17 score ≤ 7). Univariable analysis was performed to identify potential influencing factors, followed by multivariable logistic regression to determine independent associated factors and interaction effects.
Among 746 participants, 84 were diagnosed with GDM (incidence: 11.26%). Univariable analysis revealed that GDM was significantly associated with advanced maternal age (≥ 35 years), pre-pregnancy overweight/obesity (BMI ≥ 24 kg/m²), adverse pregnancy history, family history of diabetes, polycystic ovary syndrome (PCOS), poor dietary habits, insufficient physical activity, poor sleep quality, and elevated serum estradiol (E2), progesterone (P), and cortisol (Cor) levels (P < 0.05). Multivariable logistic regression confirmed these factors as independent associated factors for GDM (P < 0.05). Among the 84 GDM patients, 27 (32.14%) had comorbid depression. Univariable analysis identified adverse pregnancy history, elevated E2/P/Cor levels, personal/family history of depression, unintended pregnancy, poor glycemic control, GDM-related complications, and low social support (SSRS score < 33) as potential associated factors for depression (P < 0.05). Multivariable analysis further demonstrated that adverse pregnancy history, elevated E2/P/Cor levels, prior depression history, poor glycemic control, and low social support were independent associated factors for comorbid depression (P < 0.05). Interaction analysis using Jvenn ( https://jvenn.toulouse.inrae.fr/app/example.html ) revealed that adverse pregnancy history and elevated E2/P/Cor levels were shared influencing factors for both GDM and comorbid depression.
(1) Advanced maternal age, pre-pregnancy overweight/obesity, adverse pregnancy history, diabetes family history, PCOS, poor lifestyle habits, and elevated E2/P/Cor levels are independent associated factors for GDM. (2) Adverse pregnancy history, elevated E2/P/Cor levels, prior depression history, poor glycemic control, and low social support are independent associated factors for comorbid depression in GDM patients. (3) Adverse pregnancy history and elevated E2/P/Cor levels represent shared interaction factors influencing both conditions.
探讨妊娠期糖尿病（GDM）孕妇合并抑郁症的发病率及影响因素，分析其交互作用，并提出针对性干预策略。
对2022年3月至2024年3月在我院进行定期产前检查的746例孕妇的临床资料进行回顾性分析。所有参与者在妊娠24 - 28周时采用口服葡萄糖耐量试验（OGTT）筛查GDM。根据GDM诊断结果，将队列分为GDM组和非GDM组，比较两组的人口统计学和临床指标。对于GDM患者，采用汉密尔顿抑郁量表17项版（HAMD - 17）评估抑郁症状，分为筛查阴性组（HAMD - 17评分>7）和筛查阳性组（HAMD - 17评分≤7）。进行单因素分析以确定潜在影响因素，随后进行多因素逻辑回归以确定独立相关因素及交互作用。
746例参与者中，84例被诊断为GDM（发病率：11.26%）。单因素分析显示，GDM与高龄产妇（≥35岁）、孕前超重/肥胖（BMI≥24 kg/m²）、不良孕产史、糖尿病家族史、多囊卵巢综合征（PCOS）、不良饮食习惯、体育活动不足、睡眠质量差以及血清雌二醇（E2）、孕酮（P）和皮质醇（Cor）水平升高显著相关（P<0.05）。多因素逻辑回归证实这些因素为GDM的独立相关因素（P<0.05）。84例GDM患者中，27例（32.14%）合并抑郁症。单因素分析确定不良孕产史、E2/P/Cor水平升高、个人/家族抑郁症病史、意外妊娠、血糖控制不佳、GDM相关并发症以及社会支持低（社会支持评定量表评分<33）为抑郁症的潜在相关因素（P<0.05）。多因素分析进一步表明，不良孕产史、E2/P/Cor水平升高、既往抑郁症病史、血糖控制不佳以及社会支持低是合并抑郁症的独立相关因素（P<0.05）。使用Jvenn（https://jvenn.toulouse.inrae.fr/app/example.html）进行的交互分析显示，不良孕产史和E2/P/Cor水平升高是GDM和合并抑郁症的共同影响因素。
（1）高龄产妇、孕前超重/肥胖、不良孕产史、糖尿病家族史、PCOS、不良生活习惯以及E2/P/Cor水平升高是GDM的独立相关因素。（2）不良孕产史、E2/P/Cor水平升高、既往抑郁症病史、血糖控制不佳以及社会支持低是GDM患者合并抑郁症的独立相关因素。（3）不良孕产史和E2/P/Cor水平升高是影响两种情况的共同交互因素。
