If you're diagnosed with gestational diabetes, the type that occurs during pregnancy, you may also be at an increased risk for developing postpartum depression, according to a new study that tracked more than 700,000 women. 1
''Gestational diabetes makes someone 70% more likely to experience postpartum depression," says Michael E. Silverman, PhD, assistant professor of psychiatry at Icahn School of Medicine at Mount Sinai. He terms that risk significant from a statistics point of view, but calls it a modestly increased risk.
Even so, he says, women who learn they have gestational diabetes should be aware of the possibility of postpartum depression so they can be on the alert for the symptoms after they give birth—and get mental health help if needed.
Gestational diabetes, abnormally high blood sugar during pregnancy, can affect the health not only of the mother but the baby. It occurs late in pregnancy, putting the baby at risk for breathing problems, a higher risk of becoming obese and developing type 2 diabetes. 2
Postpartum depression is one of the most common non-obstetric complications of childbirth, according to Dr. Silverman. It's far more serious than the transient ''baby blues,'' in which a new mother reports mood swings, crying and sleeping difficulties soon after giving birth and up to a couple of weeks after.
Postpartum depression includes the same symptoms, but is more persistent and severe.
Dr. Silverman and his team evaluated data from the Swedish Medical Birth Register, including all Swedish-born women who delivered their first baby, a singleton (not twins), between the years 1997 through 2008.
The researchers had medical information on all the women and looked at multiple potential risk factors besides gestational diabetes. They looked, for instance, at women with and without a history of depression.
Compared to women who did not develop gestational diabetes, those with it had the 70% increased risk of postpartum depression. The researchers used the definition of postpartum depression from the American College of Obstetrics and Gynecology, terming it a depression diagnosis within 12 months after the delivery date.
Overall, having gestational diabetes upped the risk of postpartum depression, but women with a history of depression had an even greater risk, Dr. Silverman says. Those with a history of depression were 20 times as likely to get postpartum depression than those who never had a diagnosis of depression.
The study is published online Jan. 18 in the journal Depression and Anxiety.
Dr. Silverman stresses that his team found a link, or association, but can't prove cause and effect. "We don't know if depression causes diabetes or diabetes causes depression," he says.
He suspects that inflammation—which plays a role in both gestational diabetes and postpartum depression—may be the common link explaining the association.
"Most clinicians consider gestational diabetes and postpartum depression two very different things," Dr. Silverman says. "We're saying, given this large study and the risk we find, we need to consider these things together."
The study findings don't surprise Emily S. Miller, MD, assistant professor of maternal-fetal medicine at Northwestern University Feinberg School of Medicine. "It seems women with diabetes in general tend to have an increased incidence of depression," she says.
In her recent study, published in Feb. 2016 in the Archives of Women's Mental Health, she found that postpartum depression was more than twice as likely among women diagnosed with diabetes before pregnancy. However, she did not find gestational diabetes linked with increased rates of depression. 3
However, she says, her study looked at only 305 women, a much smaller number than Dr. Silverman's. She says there probably were not enough women in the study to show the link with gestational diabetes.
Women should be screened for depression during pregnancy, Dr. Silverman and Dr. Miller agree. The American College of Obstetricians and Gynecologists advises doctors to screen pregnant women for depression at least once. Depression, of various severities, affects one in seven women during pregnancy and 12 months after delivery, according to ACOG. 4
Talk therapy, medication or a combination of both can be very successful to treat pregnancy-related depression, Dr. Miller says.
Managing the gestational diabetes is important, too, of course. In another recent study, 10 pregnant women with newly diagnosed gestational diabetes who took part in weekly alternating telehealth conferences and office visits reached the targets recommended by the American Diabetes Association for their blood glucose levels. That study is published online Jan. 11 in Diabetes Care. 5