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Association Between Diabetes and Perinatal Depression Among Low-Income Mothers

Kozhimannil, Katy Backes; Pereira, Mark A.; Harlow, Bernard L.

Obstetrical & Gynecological Survey: July 2009 - Volume 64 - Issue 7 - p 441-443
doi: 10.1097/01.ogx.0000351679.70177.2b
Obstetrics: Medical Complications of Pregnancy

Earlier studies have shown a clear association between depressive disorders and diabetes in adult populations. Although it is known that 10% to 12% of new mothers have perinatal depression and pregnancies in 2% to 9% of women are complicated by diabetes, the association between depression and preexisting diabetes in pregnant women and new mothers is not well characterized. This retrospective cohort study investigated the association between diabetes and depression in the perinatal period among a sample of low-income women, and also examined the effect of diabetes on new onset of depression during the postpartum period. The study population included 11,024 women, identified in New Jersey's Medicaid administrative claims database, who gave birth over a 2-year period and were continuously enrolled in Medicaid for at least 6 months before delivery through 1 year after giving birth. The prevalence of diabetes in this population was 6%. The annual income of these mothers was below the federal poverty line. Occurrence of both diabetes and depression was assessed during the 6 months before and up to 1 year after delivery. Diabetes was defined as having a diabetes diagnosis (either diabetes mellitus or gestational diabetes) or filling a prescription for a diabetes medication, and depression was defined as either having a diagnosis or a prescription drug claim for an antidepressant medication.

After adjustment for age, race, year of delivery, and gestational age at birth, women with diabetes during pregnancy or the postpartum period were twice as likely to have depression as women without diabetes (adjusted odds ratio: 1.85; 95% confidence interval [CI]: 1.45–2.36). When evaluated according to the type of diabetes, the odds ratio (OR) was as follows: 1.96 (1.27–3.04) for gestational diabetes treated with insulin, 1.72 (1.11–2.66) for gestational diabetes not on insulin, and 1.89 (1.33–2.67) for pregestational diabetes not on insulin. The risk of depression did not reach significance in women with pregestational diabetes on insulin. Women with diabetes but no prenatal depression (9.6%, n = 62) had greater odds of having new onset depression during the postpartum period compared with those without diabetes (5.9%, n = 604); the adjusted odds ratio was 1.69, with a 95% CI of 1.27 to 223.

These findings indicate that, in this population of low-income pregnant women and new mothers, those with diabetes had nearly twice the risk of experiencing depression during pregnancy or the postpartum period than women without diabetes; the risk of new onset postpartum depression was increasing even among women who did not have depression during the prenatal period.

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; and Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota

JAMA 2009;301:842–847

© 2009 Lippincott Williams & Wilkins, Inc.