Low-income mothers with pre-pregnancy or gestational diabetes have a higher risk of experiencing depression during the perinatal and postnatal periods than women without diabetes. Bernard L. Harlow, PhD, University of Minnesota School of Public Health, and colleagues1 reported their findings in the February 2009 issue of the JAMA. The study consisted of 11,024 fee-for-service Medicaid recipients from New Jersey who gave birth between July 1, 2004, and September 30, 2006.
Diabetes was defined as “having a diabetes diagnosis or filling a prescription for a diabetes medication either during the 6 months before delivery or 1 year following delivery.” Depression was defined as having a diagnosis of depression or filling a prescription for antidepressant medication. According to the researchers, this is the first study to determine an association between any form of diabetes and depression during the prenatal period. New-onset depression may occur in the postpartum period in mothers with diabetes who were not depressed during the prenatal period.
After adjusting for age, gestational age at delivery, cesarean section delivery, and race (36.4% white, 46.0% black, 17.5% other), perinatal depression risk in patients with diabetes was 15.2% compared with 8.5% in those with no indication of diabetes. The risk of experiencing new-onset depression in the postpartum period was higher in women with diabetes (9.6%) than in women without diabetes (5.9%).
These findings indicate that women who have diabetes in the perinatal and postpartum periods are at greater risk for experiencing depression than women without diabetes. Although causality could not be determined, Harlow and colleagues comment that the findings are “notable because women using state Medicaid services may be particularly vulnerable to postpartum depression due to higher rates of known risk factors, including stressful life events and limited emotional, social, or financial support … and, as such, state Medicaid programs may want to encourage health care providers to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period.”
1. Kozhimannil KB, Pereira MA, Harlow BL. Association between diabetes and perinatal depression among low-income mothers. JAMA. 2009;301:842-847.