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Diabetes Linked to Depression During and After Pregnancy

Study was based on more than 11,000 low-income mothers,,,,

TUESDAY, Feb. 24 (HealthDay News) -- Low-income women with diabetes who are pregnant or recently gave birth face almost twice the risk of depression compared to women without the blood sugar disorder, a new study found.

And, it didn't matter whether the women developed diabetes before or during pregnancy, or if they were taking insulin or oral medications. The risk of depression was still much stronger for women with diabetes, the study found.

"Those with diabetes have nearly twice the risk of depression during pregnancy and post-partum," said the study's lead author, Katy Backes Kozhimannil, a research fellow in the department of ambulatory care and prevention at Harvard Medical School in Boston.

And, Kozhimannil added, women who'd never been depressed before appeared to be at risk, too. "One in 10 women who had no indication of prior depression received a diagnosis of depression within a year following delivery," she said.

Results of the study were published in the Feb. 25 issue of the Journal of the American Medical Association.

Although the study didn't look at potential reasons for this association, Kozhimannil said there are biological changes that occur with diabetes that might increase the risk of depression. She also said the stress of managing a chronic illness might contribute to the risk of depression.

Post-partum depression affects about 10 percent of new mothers, usually between two and six months after birth, according to background information in the study. If left untreated, post-partum depression can affect the mother-child relationship as well as the child's development.

Risk factors for post-partum depression include a history of depression, troubled relationships, domestic violence, stressful life events, financial problems, lack of social or emotional support, a difficult pregnancy or delivery, and health problems with the baby. Previous studies have linked diabetes to an increased risk of depression in general, according to the study authors.

To assess whether or not diabetes is a factor in pre- and post-partum depression, Kozhimannil and her colleagues reviewed data on more than 11,000 women who gave birth between 2004 and 2006. All of the women were continuously enrolled in Medicaid during the study period.

From this low-income population, the researchers found that 15.2 percent of women with diabetes developed depression during or after their pregnancy. In women without diabetes, that number was 8.5 percent. In women who'd never been depressed before, 9.6 percent of those with diabetes developed depression, compared to 5.9 percent of those without the blood sugar condition.

"Health-care facilities need to pay particular attention for depression in women with diabetes during the post-partum period," said Kozhimannil. "Both diabetes and depression in the post-partum period are treatable."

Dr. Robert Welch, chairman of obstetrics and gynecology at Providence Hospital in Southfield, Mich., called the new research an interesting study, but said it left some important questions unanswered. For example, he wondered how many of these pregnancies were planned, and exactly how many of the women with diabetes were newly diagnosed?

"A new diagnosis may be overwhelming for a lot of women," he said.

Also, in a Medicaid population, it can be more difficult to get diabetes well monitored, which could add to the stress these women are already feeling, Welch said. "Diabetes is an expensive disease, and this study calls out the need for additional mid-level providers who have more time to assist in making [a depression] diagnosis," he said.

Both Welch and Kozhimannil said that while this study was done with low-income women, the findings may be similar for higher-income women, though the stressors may be different.

Welch recommended that no matter what your income, if you're expecting, you should try to set up a support system before the baby arrives. Try to set up extra help so you're not alone with the baby day after day, he said.

"Years ago, when you brought a baby home, grandma and other family members were there. Now, grandmothers are working. And, if you have diabetes, too, it's an overwhelming situation. You're fatigued from the new baby and have the stress of managing diabetes," he said.

More information

To learn more about pregnancy and depression, including symptoms of depression to watch for, visit the U.S. National Women's Health Information Center.

SOURCES: Katy Backes Kozhimannil, M.P.A., research fellow, department of ambulatory care and prevention, and doctoral candidate, Harvard Medical School, Boston; Robert Welch, M.D., chairman, obstetrics and gynecology, Providence Hospital, Southfield, Mich.; Feb. 25, 2009, Journal of the American Medical Association

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