Abstract
BackgroundStudies have found an association between obesity and an increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Therefore, our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity.MethodsAdministrative health data (2002/03–2018/19) were used to identify a cohort of women (age 15+ years) who gave birth (N = 250,746) and had no pre-existing mood/anxiety disorders or diabetes (N = 222,863 excluded). Women were then divided into two groups: lean (N = 17,975) and with obesity (N = 9908), which was identified by a recorded maternal weight of > 38 to < 65.6 kg and ≥ 85 to < 186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery).ResultsThe unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00–9.15) than in the lean group (6.93%; 95% CI 6.56–7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17–1.39; p < 0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83–2.02; p = 0.248).ConclusionThis is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a possible preventative measure. However, the biological mechanism behind the observed positive effect of insulin on PPD rates remains to be investigated.
Highlights
In 2017, 25.0% of Canada’s female population aged 18–34 years were considered overweight and 19.3% were considered to have obesity [1]
In the lean group, < 1.0% of mothers were treated with insulin during pregnancy while in the obesity group, 2.40% of mothers were treated with insulin (Table 1)
The risk of Postpartum psychological distress (PPD) was higher in the obesity group (8.56%; 95% confidence intervals (CI) 8.00–9.15) than in the lean group (6.93%; 95% CI 6.56–7.33) (Table 2)
Summary
In 2017, 25.0% of Canada’s female population aged 18–34 years were considered overweight and 19.3% were considered to have obesity [1]. There is a strong association with pre-pregnancy obesity and screening positive for postpartum depression [6, 7]; and it is estimated that 10–13% of women will develop a depressive episode postpartum [8]. It is necessary to identify markers and potential therapeutic targets for early diagnosis, treatment and prevention of postpartum depression. Studies have found an association between obesity and an increased risk for peripartum depression, which has been linked to decreased placental lactogen levels. Women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity
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