776: The association between diabetes, obesity and perinatal depression

Abstract

The existing literature suggests a bidirectional relationship between diabetes and depression. Recently, a small study found a possible association between pre-existing diabetes and postpartum depression. The latter has also been linked to obesity. The aims of this study are to estimate if (1) diabetic or obese women are more likely to experience depressive symptoms at any point in pregnancy than non-diabetic and non-obese women, and if (2) a positive 1st trimester depression screen is associated with development of gestational diabetes (GDM). This is a retrospective cohort study of women who received prenatal care at an urban tertiary academic hospital from Jan2008-Dec2014. Depression screening was performed at each trimester and postpartum using the Patient Health Questionnaire (PHQ9) with a score of ≥10 to be indicative of depression. The incidence of a positive depression screen at any point during or after pregnancy was compared among women, stratified by diabetes status and subsequently by obesity status. The incidence of GDM was compared in women with and without a positive 1st trimester depression screen. Bivariable and multivariable analyses were used as appropriate. Of the 4955 pregnant women that met inclusion criteria, 324 (6.5%) had pre-pregnancy diabetes, 417 (8.4%) had GDM and 813 (16.4%) were obese. There were no differences in a positive depression screen between diabetics and non-diabetics (1st trimester 6.3% vs 8.7%, p=0.45; 2nd trimester 5.8% vs 10.2%, p=0.2; 3rd trimester 5.1% vs 10.9%, p=0.08; postpartum 4.8% vs 3.2%, p=0.3). There were no differences in a positive depression screen stratified by antenatal obesity (1st trimester 5.4% vs 8.3%, p=0.07; 2nd trimester 9.5% vs 4.3%, p=0.28; 3rd trimester 4.4% vs 6.9% p=0.14). Women with obesity had a higher incidence of postpartum depression (3.8% vs 6.6%, p=0.04) but after adjusting for potential confounders this association was no longer significant (aOR=0.698, 95% CI = 0.47-1.05). There were no differences in the development of GDM (6.8% vs 12.1%, p=0.12) in women with and without 1st trimester depression. We found no association between pre-existing diabetes and perinatal depression and between antenatal depression and development of GDM. While obesity was associated with an increased risk of postpartum depression, this association did not persist after adjusting for confounders.