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Diabetes Linked to Pregnancy-Related Depression in Low-Income Women

Posted: Wednesday, March 11, 2009

Among low-income pregnant women, those with diabetes have almost twice the odds of having perinatal depression and are also more likely to have postpartum depression, researchers report.

Postpartum depression, which affects about 10% to 12% of new mothers, can have long-lasting negative effects. Similarly, diabetes, which is found in up to 9% of pregnant women, is associated with pregnancy complications, the authors write.

In a retrospective cohort study of pregnant Medicaid patients, 15.2% of women with prepregnancy or gestational diabetes, vs 8.5% of women without diabetes, were depressed in the perinatal period, which encompassed the last six months of pregnancy to one year after delivery.

Among women who did not have prenatal depression, 9.6% of women with diabetes vs 5.9% of women without diabetes developed postpartum depression.

Lead author Katy Backes Kozhimannil, from Harvard Medical School, in Boston, Massachusetts states, "Our findings show a relationship between 2 illnesses — diabetes and depression — that are common during pregnancy and the postpartum period.”

"It is highly important to note that postpartum depression is treatable, but it is underdiagnosed," she said. "Healthcare providers, clinicians, and facilities that serve low-income and Medicaid populations may want to pay particular attention to managing the mental healthcare concerns of women with diabetes during pregnancy and the postpartum period."

One in 10 new mothers has postpartum depression and risk factors for postpartum depression include previous depression, stressful life events, difficult delivery, and neonatal health problems.

Studies have established a link between diabetes and depression in the general population, but to date, no research has characterized the relationship between these two illnesses among pregnant women and new mothers.

"A low-income population that uses state Medicaid services may be particularly vulnerable to perinatal depression, because they have higher rates of a number of known risk factors, including stressful life events, and limited emotional, social, and financial support," said Ms. Kozhimannil.

To examine the association between diabetes and depression during the perinatal period, the researchers performed a retrospective cohort study of 11,024 women living in New Jersey who gave birth between July 1, 2004, and September 30, 2006, and were covered by Medicaid for perinatal care.

After adjustment for multiple factors, women with diabetes were almost twice as likely as women without diabetes to experience depression during the perinatal period. This relationship remained consistent for different types of diabetes: preexisting or gestational diabetes with or without the use of insulin.

Similarly, among women with no prenatal depression, those with diabetes had higher odds of new-onset postpartum depression.

In the meantime, "among all women with depression, diabetes, or other mental or physical health conditions that complicate the normal course of pregnancy and postpartum recovery, careful monitoring and appropriate treatment are critical to ensuring the health of the mother and her child," they note.

Pregnant women are usually screened for diabetes between 24 and 28 weeks gestation, and they should be screened for depression during pregnancy and at a 6-week follow-up, said Ms. Kozhimannil.

Source: Diabetes In Control: JAMA. Feb 25, 2007;301:842-847.

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