Mental health and its associations with weight in women with gestational diabetes mellitus. A prospective clinical cohort study

Measuring psychological well-being in a danish pregnancy cohort using the self-reported WHO-5 index

BACKGROUND

Reduced well-being and depressive episodes frequently complicate pregnancy and can result in serious adverse outcomes for both mother and infant if left untreated. This study aimed to assess the psychometric validity of the 5-item World Health Organization index (WHO-5), and to evaluate if the WHO-5 index can serve as a proxy for two items of core depressive symptoms from the Major Depression Inventory (MDI), identified as MDI-2. Additionally, the paper aimed to assess well-being and detect risk factors of reduced well-being using the WHO-5 index.

METHODS

Using the WHO-5 index, this study analyzed the psychological well-being of a population of 37,129 women in their first trimester of pregnancy. The psychometric validity of the WHO-5 index was evaluated using confirmatory factor analysis and item response theory. Furthermore, cut-off scores of the WHO-5 index previously associated with mental distress, ≤ 50 and ≤ 28, were evaluated in terms of sensitivity, specificity, and positive- and negative predictive values compared to the MDI-2 in a subsample of n = 1001 women.

RESULTS

Lower mean score on the WHO-5 index was seen among pregnant women ≤ 25 years old, with lower educational level, who were unemployed, nulliparous, did not understand Danish language, were not cohabitating, were smokers, and women who did not exercise prior to pregnancy. The WHO-5 index was found to be a valid psychometric instrument, however, scores could not be pooled or compared across women who understood Danish and women who did not understand Danish. The sensitivity and specificity of cut-off score of ≤ 50 on the WHO-5 index with a for predicting the presence of one core symptom from the MDI-2 was 0.81 and 0.82, respectively, while the sensitivity and specificity using a cut-off of ≤ 28 was 0.32 and 0.98, respectively.

CONCLUSIONS

The WHO-5 index had high degree of acceptability and identified well-known risk factors of mental distress in a pregnant population. The WHO-5 index was found to be a valid psychometric instrument in pregnancy, however, our analysis indicated low predictive value of the investigated cut-off scores on the WHO-5 index in identification of MDI-2 core symptoms.

Cardio-Metabolic and Mental Health Outcomes Before and During the COVID-19 Pandemic in a Cohort of Women With Gestational Diabetes Mellitus in Switzerland

Background

The COVID-19 pandemic has been associated with worsened metabolic and mental health in the general and perinatal population. The postpartum is a critical moment regarding these outcomes particularly in women with gestational diabetes mellitus (GDM). We investigated the cardio-metabolic and mental health outcomes before and during the pandemic in this population.

Methods

This cohort study included 418 women with GDM, recruited during two distinct periods. This included 180 women exposed to the pandemic (E+) and recruited between May 2020-April 2021 and 238 women who were not exposed to the pandemic during their postpartum period (attended a year before=non-exposed (E-)) and recruited between January-December 2019. Among the E+, a nested-subcohort of 120 women were exposed both during pregnancy and postpartum. During the pandemic, we adopted a hybrid follow-up of women that consisted of in-person consultations, regular contact via phone calls (35%), sent recorded exercise guide to patients to follow at home and linked to our website. We specifically focused on maintaining motivation and keeping a strong focus on healthy lifestyle behaviors. Obstetric, neonatal, cardio-metabolic and mental health outcomes were assessed during pregnancy and postpartum.

Results

The pandemic was not associated with worsened weight, weight retention, glucose tolerance, metabolic syndrome, well-being or depression in the postpartum with the exception of a minimally increased HbA1c, diastolic blood pressure and lower emotional eating scores in E+ women (all p ≤ 0.046). In the nested subcohort, E+ women had a slightly increased HbA1c at the first GDM visit and a higher need for glucose-lowering medication (both p ≤ 0.014), but HbA1c at the end of pregnancy and other cardio-metabolic, mental health, obstetric and neonatal outcomes during pregnancy were similar.

Conclusions

The pandemic was not associated with any clinically relevant worsening of cardio-metabolic, mental health, obstetrical and neonatal outcomes in our GDM cohort. This was possibly due to a continued hybrid follow-up, and the partial lockdown in Switzerland.

Cardiometabolic and Mental Health in Women With Early Gestational Diabetes Mellitus: A Prospective Cohort Study

CONTEXT

Early diagnosis and treatment of gestational diabetes (GDM) may reduce adverse obstetric and neonatal outcomes, especially in high-risk women. However, there is a lack of data for other outcomes.

OBJECTIVE

We compared cardiometabolic and mental health outcomes in women with early (eGDM) and classical (cGDM) GDM.

METHODS

This prospective cohort included 1185 All women with cGDM and 76 women with eGDM. The eGDM group had GDM risk factors (BMI >30 kg/m2, family history of diabetes, history of GDM, ethnicity), were tested at <20 weeks gestational age, and diagnosed using American Diabetes Association prediabetes criteria. All women underwent lifestyle adaptations. Obstetric, neonatal, mental, and cardiometabolic outcomes were assessed during pregnancy and postpartum.

RESULTS

The eGDM group had lower gestational weight gain than cGDM (10.7 ± 6.2 vs 12.6 ± 6.4; P = 0.03) but needed more medical treatment (66% vs 42%; P < 0.001). They had similar rates of adverse maternal and neonatal outcomes, except for increased large-for-gestational-age infants (25% vs 15%; P = 0.02). Mental health during pregnancy and postpartum did not differ between groups. eGDM had more atherogenic postpartum lipid profile than cGDM (P ≤ 0.001). In eGDM, the postpartum prevalence of the metabolic syndrome (MetS) was 1.8-fold, prediabetes was 3.1-fold, and diabetes was 7.4-fold higher than cGDM (waist circumference-based MetS: 62% vs 34%/BMI-based MetS: 46% vs 24%; prediabetes: 47.5% vs 15.3%; diabetes: 11.9% vs 1.6%, all P < 0.001). These differences remained unchanged after adjusting for GDM risk factors.

CONCLUSION

Compared with cGDM, eGDM was not associated with differences in mental health, but with increased adverse cardiometabolic outcomes, independent of GDM risk factors and gestational weight gain. This hints to a preexisting risk profile in eGDM.