Relationship between depression and diabetes in pregnancy: A systematic review

Table 3 Outcomes of included studies involving women with any type of diabetes (not specified or data grouped)

First authorstudy design	Definition/measures of depression	Timing of depression measures	Overall nSubgroups, n	Main outcomes/findings
Ahmed[21] Prospective, cross-sectional	EPDS ≥ 10	6-8 wk postpartum	n = 1000 With DM (type NR), n = 31 No DM, n = 969	The proportion of women with DM who had PPD (51.6%) was significantly higher than the proportion of women without DM who had PPD (27.7%) (P = 0.004) Calculated prevalence of women with both DM and PPD was 1.6% (16 of 1000)
Bansil[22] Retrospective	ICD9 codes 296.2, 296.3, 300.4, 311, 298.0, 309.0, 309.1	At the time of delivery	n = 32156438 With depression, n = 244939; With DM (type 1, type 2, or GDM), n = 1536514 With DM and depression, n = 18245	Rate of concurrent DM at the time of delivery higher in women with depression (74.5 per 1000 deliveries) vs women without depression (47.6 per 1000 deliveries; OR (95%CI): 1.52 (1.47-1.58)] Calculated prevalence of DM and depression = 0.06% (18245 of 32156438 deliveries)
Benute[24] Prospective	PRIME-MD	During prenatal outpatient visits/hospital-isation	n = 326 With DM, n = 84 With MDD, n = 29	Prevalence of DM in women with MDD was 7.1% Calculated prevalence of DM and MDD = 0.61% (7.1% of 29 = 2; 2/326 = 0.61%)
Berger[25] Retrospective	EPDS ≥ 13 or did not answer “No” to self-harm question	Within 4 d after delivery	Unselected, n = 322 History of mental illness, n = 215	Prevalence of any DM did not differ between women with or without postpartum depression in either the unselected group or the group with history of mental illness
Chen[32] Retrospective	ICD9 codes 296.2, 296.3, 300.4, and 311	History of depression within 2 years before delivery	n = 5283 With DM (type NR), n = 319	Calculated prevalence of DM among women with depression was 6.0%
Kozhimannil[46] Retrospective cohort	ICD9 codes 296.2, 296.3, 300.4, 301.12, 309.1, and 311	During the 6 mo before and up to 1 year after delivery	n = 11024 With DM (pre-existing or GDM), n = 657;	Overall calculated prevalence of women with both DM (any type) and depression was 1.1% Prevalence of depression among women with any DM was 15.2% vs 8.5% among women without DM (P value not reported)
Ragland[54] Prospective, cross-sectional	BDI > 13	During pregnancy	No DM, n = 10367 n = 50 Type 1 DM, n = 8 Type 2 DM, n = 20 GDM, n = 22	Women with any DM had an increased odds of experiencing depression during or after pregnancy [OR (95%CI): 1.85 (1.45-2.36)] vs women without DM Women with any DM and no prenatal depression (9.6%) had increased odds of experiencing PPD or taking an antidepressant in the year after delivery [OR (95%CI): 1.69 (1.27-2.23)] vs women without DM Mean (SD) BDI score was 14.1 (9.9), range 3-43 Number (%) women with DM and severe (BDI ≥ 29), moderate (BDI 20-28), mild (BDI 14-19), and minimal (BDI 0-13) depression was 5 (10%), 8 (16%), 8 (16%), and 29 (58%) 42% of women with DM had BDI scores > 13, indicating clinical depression Among patients with clinical depression, only 19% were receiving treatment for depression Number of pregnancies showed a positive correlation with BDI score (P = 0.0078) Least mean squares of HbA1c level was higher, but not significantly, in women with depression [7.3% (56 mmol/mol)] than in those without [6.9% (52 mmol/mol)] (P≥ 0.05)
Räisänen 2013[56] Retrospective, registry review	ICD10 codes F31.3, F31.5, and F32-34	Up to 6 wk postpartum or a history of depression	n = 511422	Calculated prevalence of DM (any type) and depression in pregnant women = 0.06%
Singh[59] Retrospective	BDI ≥ 10; self-reported medical history	During pregnancy	n = 152 History of depression, n = 39 No history of depression, n = 113	Current BDI scores were higher in women with DM and history of depression [mean (SD) 17.2 (11.5)] than in women with DM and no history of depression [7.8 (7.4), P < 0.0001] Percentage of women with BDI ≥ 10 significantly greater in women with DM and history of depression (72%) than in women with DM and no history of depression (28%, P < 0.0001)
York[65] Prospective	Multiple Adjective Check List	36 wk gestation, and 2 d, 1 wk, 4 wk, and 8 wk postpartum	n = 36 Pre-existing DM, n = 6 GDM, n = 30	Most women did not report high levels of depression Among all women with DM, depression scores decreased significantly (P < 0.001) over time [mean (SD) scores of 9.2 (6.6), 10.1 (8.3), 6.7 (8.2), 5.6 (7.0), and 3.8 (4.2) at 36 wk gestation, 2 d postpartum, 1 wk postpartum, 4 wk postpartum, and 8 wk postpartum, respectively] There were no differences between women with GDM and women with pre-existing DM in depression scores during pregnancy (P = 0.17) or postpartum (P value not reported)

BDI: Beck Depression Inventory; CI: Confidence interval; DM: Diabetes mellitus; EPDS: Edinburgh Postnatal Depression Scale; GDM: Gestational diabetes mellitus; ICD: International Classification of Disease; MDD: Major depressive disorder; NR: Not reported; PPD: Postpartum depression; PRIME-MD: Primary Care Evaluation of Mental Disorders classification system; SD: Standard deviation.