Gestational Diabetes Increases Risk for Postpartum Depression
Researchers from the Icahn School of Medicine at Mount Sinai and the Karolinska Institutet have found that gestational diabetes raises the risk of postpartum depression (PPD) in first-time mothers. This is the largest study of its kind to date, including more than 700,000 women. The results were published online today in the journal Depression and Anxiety.
The researchers also established that women with a history of depression are more than 20 times more likely to experience PPD than mothers without a previous clinical diagnosis of depression. And while gestational diabetes alone increased risk for PPD, a history of maternal depression in conjunction with gestational diabetes further increased the likelihood of PPD.
“Most practitioners think of these as two isolated and very different conditions, but we now understand gestational diabetes and postpartum depression should be considered together,” says Michael E. Silverman, PhD, an Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, and lead author of the study. “While having diabetes increases PPD risk for all women, for those women who have had a past depressive episode, having diabetes during pregnancy makes it 70 percent more likely that they will develop PPD.”
In addition to gestational diabetes, the researchers studied more than a dozen other risk factors, including pre-gestational diabetes, for association with PPD in women with and without a history of depression. Among women with a history of depression, pre-gestational diabetes and mild preterm delivery increased risk. Young age, instrument-assisted or cesarean delivery, and moderate preterm delivery increased risk in women who had no history of depression.
Studying the modifying effect of maternal depression on pre- and perinatal PPD risk factors sheds new light on the relationship between diabetes and depression. Showing that a history of depression modifies some of the risks associated with obstetric and perinatal factors suggests that there may be different causal pathways of PPD in women with and without a history of depression.
PPD can result in negative personal and child developmental outcomes, and identifying previous depressive episodes as a risk factor for PPD allows doctors to pursue earlier interventions. “The reason a doctor asks if you smoke is because they know you are 20 times more likely to get cancer if you do. We believe OB/GYNs should now do the same for depression history,” Dr. Silverman said. “With this information, we can now intervene early, before the mother gives birth.”
This is the largest population-based study to date to characterize PPD in relation to depression history. Researchers used the nationwide Swedish Medical Birth Register, which includes information on all births in Sweden. Unlike in past studies, researchers relied on clinical diagnoses of PPD since symptom-based PPD inventories have a tendency to overestimate the prevalence of the condition.
The study was funded by the U.S. National Institute of Child Health and Development. The team included researchers from the Department of Psychiatry and The Seaver Autism Center for Research and Treatment at the Icahn School of Medicine at Mount Sinai; the Karolinska Institutet in Stockholm, Sweden; and Brown University.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.