Antenatal depression moderated the association between gestational diabetes mellitus and fetal hyperinsulinism

Abstract

Gestational diabetes mellitus (GDM) and antenatal depression are common comorbidities. However, the combined effects of antenatal depression and diabetes during pregnancy on fetal β-cell function are unknown. We aimed to test whether the association of maternal GDM and glucose metabolism with cord blood C-peptide levels varies with antenatal depression. Data on mother-child pairs (N=5,734) from the Maternal and Infant Health Cohort Study in Hefei were analyzed. GDM was diagnosed using the 75-g oral glucose tolerance test at 24-28 weeks' gestation. Antenatal depression was measured using the Edinburgh Postnatal Depression Scale during mid- and late pregnancy. Cord blood samples were collected at delivery and tested for C-peptide levels. A total of 1,054 (18.38%) mothers were diagnosed with GDM. GDM was associated with a 5.57 (95% confidence interval [CI], 3.65-7.50) percentile higher cord blood C-peptide level. This association varied with depression severity: the differences in cord blood C-peptide percentile for GDM versus non-GDM were 5.12 (95% CI, 2.81-9.75) for non-antenatal depression, 7.36 (95% CI, 2.85-13.38) for moderate antenatal depression, and 10.06 (95% CI, 4.69-14.8) for severe antenatal depression in mid-pregnancy. Similar associations stratified by antenatal depression in late pregnancy were observed. Antenatal depression was significantly positively correlated with fetal hyperinsulinism in participants with GDM but not without GDM. Antenatal depression, which is related to maternal hyperglycemia, can aggravate the risk of fetal hyperinsulinism in early life.