Oral Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Psychiatric morbidity in women with previous gestational diabetes mellitus – a nationwide register-based cohort study (#19)

Maria Hornstrup Christensen 1 2 3 , Marianne S Andersen 3 4 , Katrine H Rubin 3 5 , Ellen Aa Nohr 2 3 , Jori Aalders 1 3 , Christina A Vinter 1 2 3 , Dorte M Jensen 1 2 3
  1. Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
  2. Department of gynecology and obstetrics, Odense University Hospital, Odense, Denmark
  3. Department of clinical research, Odense University Hospital, Odense, Denmark
  4. Department of endocrinology, Odense University Hospital, Odense, Denmark
  5. OPEN - Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark

OBJECTIVE

Being diagnosed with gestational diabetes mellitus (GDM) can be a stressfull experience and impact mental health during pregnancy, yet evidence on the long-term impact of GDM on mental health is conflicting. The aims of this study were: 1) to examine associations between previous GDM and incidence of psychiatric morbidity in a large, Danish population; 2) to quantify the potential mediating effect of subsequent manifest diabetes after GDM on the risk of psychiatric morbidity; 3) to explore the potential role of proxies of insulin resistance during and after pregnancy on the psychiatric morbidity risk.

 

RESEARCH DESIGN AND METHODS

We conducted a nationwide register-based study including all women delivering in Denmark in 1997-2018. GDM exposure was based on diagnosis code and the outcome psychiatric morbidity was based on selected diagnosis codes and/or redemption of psychopharmacological medication. Proxy of insulin resistance during pregnancy was based on GDM status and insulin treatment during GDM pregnancy, whilst after pregnancy it was defined as development of manifest diabetes. Multiple Cox regression and mediation analyses were performed.

 

RESULTS

Of 660,017 women, 20,663 (3.1%) were diagnosed with GDM. Median follow-up was 9.5–12.4 years (range 0-21.9 years). Previous GDM was associated with increased risk of diagnosis of depressive disorders and anxiety disorders (aHR 1.32 (95% CI 1.22–1.42) and 1.23 (95% CI 1.11–1.36), respectively). Also, redemption of antidepressant and antipsychotic medication was associated with previous GDM (aHR 1.22 (95% CI 1.17–1.26) and 1.14 (95% CI 1.05–1.25), respectively). No significant differences were found regarding diagnosis of substance use disorders, psychotic disorders, bipolar disorders, psychiatric disease postpartum, and of anxiolytic medication. Subsequent diabetes after GDM mediated 35-42% of the association between GDM and psychiatric morbidity. Proxies of insulin resistance during pregnancy impacted risk of psychiatric morbidity as women with insulin-treated GDM were at increased risk compared to women with non-insulin-treated GDM; e.g., aHR for depression was 1.39 (95% CI 1.20–1.62) and 1.17 (95% CI 1.12–1.22) in women with insulin-treated and non-insulin-treated GDM, respectively (no GDM as reference)). However, this pattern was only evident in women without subsequent diabetes.

 

CONCLUSIONS

Overall, women with previous GDM were at increased risk of developing psychiatric morbidity, particularly depression and anxiety; however, some psychiatric outcomes were not significantly associated with GDM. Subsequent diabetes partly mediated the association between previous GDM and incident psychiatric morbidity, yet associations remained significant irrespective of subsequent diabetes. Special attention to the long-term mental health of women with GDM is warranted.