Gestational Diabetes & Mental Wellness
Authored by:
Anna Glezer, M.D.
Gestational diabetes (GDM) affects more than 9% of pregnant women, with the diagnosis usually made in the middle of the second trimester, and, unfortunately, on the rise. We know that this diagnosis can have a whole host of pregnancy related complications, so it is understandable that women who receive it find themselves with questions and worries.
Three Theories Linking Depression with Gestational Diabetes (GDM)
Did you know that depression can play a role in the diagnosis of GDM? One theory explaining this relationship is that depression can lead to increased stress and the hormone cortisol. The cortisol opposes the action of insulin, the primary hormone that is disrupted in diabetes. This impact of cortisol on insulin leads to insulin resistance and body weight, and therefore the development of gestational diabetes. In fact, treating depression (in non-pregnant populations) has shown to decrease insulin resistance.
Another theory is relates to inflammation: depression can increase the amount of inflammation in the body (through molecules called cytokines and c-reactive proteins), and insulin resistance is more likely to occur in a state of heightened inflammation.
Finally, the last theory explaining why depression might lead to a higher risk of developing GDM relates to the symptoms of depression. Women who are depressed might find themselves unable to care for themselves in pregnancy the way they would like to – perhaps being less mindful of nutrition, more emotional eating, less healthy behaviors. This is because the illness of depression can lead to low energy, fatigue, low mood and lack of motivation, all making self-care more challenging.
How Depression Affects Gestational Diabetes (GDM)
It would be ideal to be able to recognize the signs and symptoms of depression in the first trimester and treat them accordingly in order to decrease the risk of developing GDM (and many other complications associated with pregnancy depression).
This does not always happen, however, and so women with depression who develop GDM face a more uphill battle in managing the diabetes than their counterparts without co-occurring depression. The reason for this is twofold and relates again to the challenge depression presents. First, depression zaps energy and motivation and therefore makes it more difficult to adhere to a strict diet plan and manage medications or insulin. Second, depression colors a woman’s thoughts with negativity. A diagnosis of GDM on top of depression can be harsher blow and lead to even more negative feelings and thoughts.
The Reverse Relationship: Does Gestational Diabetes (GDM) Lead to More Depression?
The next logical question, since we have answered that depression can predispose to a diagnosis of GDM, is whether the reverse is also true. Studies have attempted to answer whether a diagnosis of gestational diabetes, which can be stressful, impacts mental health during the pregnancy and in the postpartum period.
There is some data on whether the diagnosis of GDM leads to an increase in maternal anxiety or depression at the time of diagnosis, later in pregnancy, and postpartum. It is important to answer this question, because we have to know if by recommending universal screening for gestational diabetes, clinicians might be causing women distress.
The data are not straightforward. Several studies have found that there is rise in anxiety upon diagnosis and during the initial treatment weeks, but women with gestational diabetes do not develop a sustained anxiety condition that continues through the pregnancy, especially after they receive treatment and counseling on how to manage their diabetes.
However, research looking into the postpartum period paints a different picture. Several studies have suggested that gestational diabetes is associated with an increased risk of postpartum depressive symptoms. In one, 34% of women with a diagnosis of GDM had symptoms of postpartum depression.
What Can Be Done?
First, it is essential to screen all pregnant women for depression. If you think you might be struggling with your mood, especially early on in pregnancy, please reach out for support.
Second, it is important to screen all women who are diagnosed with GDM also for depression, because as we discussed, depression can make the management of GDM more challenging.
Third, we have seen that women’s anxiety can decrease with clear instruction and counseling. This makes sense, as the diagnosis of GDM can be one that initially leads to fears for the pregnancy and the baby due to potential complications. Women report feeling better if they are able to maintain good healthy diets and close monitoring of blood sugar. That might mean more frequent appointments with nutritionists, more frequent medical appointments for close monitoring of what is a higher risk pregnancy, and more support from family, friends, and other moms.
Finally, close monitoring postpartum is essential. New moms might expect that the postpartum period will be ideal for beginning a new healthy lifestyle, monitoring diet, resuming exercise, and losing weight. This is a challenge to accomplish with a new infant and is that much more difficult if postpartum depression gets in the way. This means it is important to look for signs and symptoms of postpartum depression.
If depression is co-occurring with the diagnosis of GDM, treatment for the mood and anxiety symptoms is important in addition to blood sugar control. Psychotherapy during pregnancy, focusing particularly on the negative thoughts and anxieties that can be associated with the diagnosis of GDM, is one option. Postpartum, interpersonal psychotherapy that focuses on role transition is a good option. Consider meeting with your physician to discuss these treatment solutions, as well as others such as medications.
Selected References:
Morrison. C., McCook, J.G. & Bailey, B.A. (2016) First trimester depression scores predict the development of gestational diabetes mellitus in pregnant rural Appalachian women. Journal of Psychosomatic Obstetrics & Gynecology 37:1, 21-25.
Powers, K. et. al. (2013) The association between a medical history of depression and gestation diabetes in a large multi-ethnic cohort in the United States. Paediatr Perinat Epidemiol 27:4, 323-328.
Daniells, S. et. al. (2003) Gestational diabetes mellitus: Is a diagnosis associated with an increase in maternal anxiety and stress in the short and intermediate term? Diabetes Care 26, 385-389.
Nicklas, J.M. et. al. (2013) Factors associated with depressive symptoms in the early postpartum period among women with recently diagnosed gestational diabetes mellitus. Matern Child Health J. 17:9.
Walmer, R. et. al. (2015) Mental health disorders subsequent to gestational diabetes mellitus differ by race/ethnicity. Depression and Anxiety 32, 774-782.
