Abnormal screening for gestational diabetes, maternal mood disorder, and preterm birth

Authors

  • Dorothy Sit,

    Corresponding author
    1. Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • Corresponding author:

      Dorothy Sit, M.D.

      Department of Psychiatry

      University of Pittsburgh

      Western Psychiatric Institute and Clinic

      3811 O'Hara Street

      Oxford 410

      Pittsburgh, PA 15213

      USA

      Fax: 412-246-6960

      E-mail: sitdk@upmc.edu

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  • James Luther,

    1. Graduate School of Public Health, Epidemiological Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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  • John Louis (Jesse) Dills,

    1. Graduate School of Public Health, Epidemiological Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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  • Heather Eng,

    1. Graduate School of Public Health, Epidemiological Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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  • Stephen Wisniewski,

    1. Graduate School of Public Health, Epidemiological Data Center, University of Pittsburgh, Pittsburgh, PA, USA
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  • Katherine L Wisner

    1. Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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  • We presented our preliminary and recent analyses of the data at the American College of Neuropsychopharmacology 49th Annual Meeting, 5–9 December 2010, Miami Beach, FL, USA; the NCDEU 52nd Annual Meeting, 29 May to 1 June 2012, Phoenix, AR, USA; and the International Biennial Congress of The Marcé Society, 3–5 October 2012, Paris, France.
  • Clinical Trials.gov registration: NCT00279370: Antidepressant use in pregnancy; NCT00585702: Antimanic use in pregnancy.

Abstract

Objective

Gestational diabetes mellitus (GDM) affects 7% of pregnant mothers, and those with GDM have increased rates of perinatal complications. Major depressive disorder (MDD) and its pharmacologic treatments are associated with obesity and adverse pregnancy outcomes. In this prospective study, we investigated the relationship between abnormal GDM screens, maternal mood disorders, and adverse outcomes.

Methods

We examined mothers with MDD, those with bipolar disorder (BD), and healthy controls (HC) at 20, 30, and 36 weeks of gestation and delivery. We obtained demographic data and pre-pregnancy body mass index (BMI), and confirmed diagnoses with the Structured Clinical Interview for DSM-IV. We evaluated smoking, alcohol use, substance use, and medication treatments with the Longitudinal Interval Follow-up Evaluation interview. Mothers received the one-hour 50-g glucose challenge test (GCT) at 26–28 weeks of gestation. Outcome variables were preterm birth, birth weight (BW) and peripartum events.

Results

We enrolled 62 HC, 50 BD, 41 past MDD, and 39 current MDD mother–infant pairs. Mean GCT levels and the frequency of abnormal GCT (>140 mg/dL) did not differ across groups. Rates of smoking (χ2 = 20.68, df = 3, p < 0.001), substance use (χ2 = 21.76, df = 3, p < 0.001), and pre-pregnancy obesity [BMI ≥ 30 (χ2 = 9.97, df = 3, p = 0.019)] differed significantly across groups. Mothers with BD received medications associated with weight gain significantly more often than others [13/45 (29%), p < 0.001). After adjusting for group differences, GCT levels were associated significantly with increased odds for preterm birth (odds ratio = 1.29, 95% confidence interval: 1.0–1.7, p = 0.05) and increased perinatal events (beta = 0.11, p = 0.04) but were not associated with BW.

Conclusions

In mothers with or without mood disorders, having increased GCT levels contributes to a higher likelihood for adverse pregnancy outcomes. Mothers with BD or current MDD can have additional risks for adverse outcomes and may benefit from early referral for high-risk services and supportive management in pregnancy.

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