Short summary

Depression is twice as common in people with diabetes as in the general population and 1/5 pregnant women are affected by depression/anxiety. The frequency of depression/anxiety in pregnancies with pre-gestational diabetes is not known, but it's expected to be higher than in the general pregnant population. Both Depression/anxiety and pre-gestationel diabetes during pregnancy is known as potential risk factors for preterm birth and other pregnancy complications. We will investigate whether pregnant women with pre-gestational diabetes and co-existing depression/anxiety have higher risk of preterm delivery and other complications in pregnancy compared to pregnant women with pre-gestational diabetes and no depression/anxiety.

Rationale

Overall, depression is twice as common in people with diabetes as in the general population. Type 2 diabetes (T2D) and depression share a number of risk factors and biological mechanisms including: obesity, sedentary lifestyle, smoking, sleep disorders, chronic inflammation and the metabolic syndrome. The increased risk of depression in people with type 1 diabetes (T1D) might be linked to the burden of having a chronic illness with onset at a vulnerable age. Additional mechanisms could be due to biological, psychological and environmental risk factors. Recently, anxiety disorders have also been linked to the metabolic syndrome and mechanisms may include underlying chronic inflammation. 

Depression and anxiety affect approximately 18-20 % of pregnant women. The frequency of depression in pregnancies with T1D and T2D is not known, but it is expected to be higher than in the general pregnant population. Based on the clinical experience from the diabetes and pregnancy clinic, Odense University Hospital (OUH) 1/3 of pregnant women with T1D or T2D will have a diagnosis of depression and/or anxiety disorder when they enter pregnancy. Depression and anxiety have been identified as a potential risk factor for preterm birth and other adverse pregnancy outcomes including low birth weight and - to a lesser degree - preeclampsia and spontaneous abortion. Women with depression before and during their pregnancy, may experience their pregnancy as an extra load, and are less likely to participate in recommended prenatal care practices. 

Pre-gestational diabetes(T1D and T2D) are associated with a number of adverse pregnancy outcomes including fetal macrosomia, preterm delivery, hypertensive disorders, cesarean section, neonatal morbidity and in severe cases congenital malformations and fetal death. These outcomes are closely related to maternal glycemic control and therefore optimizing glucose levels peri-conceptionally and during pregnancy is crucial for pregnancy outcome. As women with mental disorders are less likely to participate in the recommended prenatal care practices this might also be true for women with T1D and T2D with coexisting depression/anxiety. This might potentially worsen glycemic control and lead to under-diagnosis and under-treatment of diabetic complications and sub-optimal obstetric care. 

Women with depression and pre-gestational diabetes are expected to be at high risk for preterm delivery and other complications. It may be important to identify and treat depression/anxiety before or early in pregnancy to reduce this risk. The present study will address the magnitude of the problem and the results can be used to design future risk stratification and treatment strategies.   

The aims of this project are 

1. To study the frequency of depression/anxiety in pregnant women with pre-gestational diabetes. 

2. To investigate associations between maternal depression/anxiety in women with pre-gestational diabetes and a) preterm delivery, b) maternal HbA1c levels before and during pregnancy and c) diabetes related maternal complications. 

Description of the cohort

Pregnant women with pre-gestational diabetes and clinical management by the diabetes and pregnancy team at Odense University Hospital during 2008-18. 

Data and biological material

Clinical data will be obtained from medical records. The data which is collected will adress pregnancy, birth, neonatal period, psychiatric disorders (depression/anxiety), diabetes mellitus and diabetes-related complications. 

Collaborating researchers and departments

Steno Diabetes Center Odense, Department of Gynechology and Obstetrics, Odense University Hospital

• Clinical professor, Dorte Møller Jensen, MD, PhD

Department of Gynecology and Obstetrics, Odense University Hospital

• Lise Lotte Torvin Andersen, MD

Steno Diabetes Center Odense, Department of Gynecology and Obstetrics, Odense University Hospital 

• Maria Hornstrup Christensen, Midwife, Cand Scient. San. PhD student