Abstract
Aims
To evaluate the impact of immigration status and sociodemographic risk factors on postpartum depressive (PPD) symptoms among women with recent gestational diabetes mellitus (GDM).
Methods
We analysed data from 327 women with recent GDM who participated in a postpartum diabetes prevention trial in Toronto, Canada. Multivariable logistic regression evaluated the association between self‐reported immigration status (Canadian‐born vs. immigrant), overall and by time since immigration (<10 years vs. ≥10 years) and PPD symptoms based on a score of ≥10 on the Edinburgh Postnatal Depression Scale.
Results
At a median 4 months postpartum, PPD symptoms were reported by 25.6% of immigrant women compared to 18.2% of Canadian‐born women (adjusted odds ratio [AOR] 1.01, 95% CI 0.50, 2.03). Time since immigration had no significant effect. Women with low household income (<C$60,000) were significantly more likely to report PPD symptoms compared to those with income >C$100,000 (AOR 3.71, 95% CI 1.61, 8.56). Among low‐income women, PPD symptom prevalence was 48%, with 52.8% in immigrant women and 35.7% in Canadian‐born women.
Conclusions
PPD symptoms are common in women with recent GDM, particularly those with low income. While the prevalence of PPD symptoms was not significantly higher in immigrant women, further studies are needed to explore subgroup‐specific risks.
Clinical Trial
Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT‐M), NCT01918345.
Keywords: diabetes prevention, gestational diabetes mellitus, immigration status, perinatal mental health, postpartum depression, socioeconomic disparities
What's new?
Women with gestational diabetes mellitus (GDM) are at increased risk of postpartum depression (PPD), but the impact of immigration on this relationship remains underexplored.
In a diverse cohort of women with recent GDM, low household income was the strongest predictor of PPD symptoms. The highest prevalence was observed in low‐income immigrant women, though immigration status alone was not significantly associated with PPD symptoms.
These findings support the need for tailored mental health screening in postpartum diabetes care, with a focus on low‐income women and culturally responsive, equity‐oriented supports.
1. INTRODUCTION
Gestational diabetes mellitus (GDM) affects 7%–28% of pregnant women with an increasing incidence. 1 GDM is defined as glucose intolerance that is first detected during pregnancy. 2 A recent study estimated a GDM prevalence of 9.5% among pregnant women who delivered in Ontario, Canada. 3 GDM is associated with an increased risk of adverse maternal and neonatal outcomes, including caesarean section, preterm delivery and fetal complications. 4 , 5 In addition to its adverse effects during pregnancy and delivery, women with GDM face an approximately tenfold higher risk of developing type 2 diabetes compared to those without a history of GDM. 6 The growing prevalence of GDM may be attributed to increasing rates of obesity, physical inactivity and older maternal age. 7
Previous studies have demonstrated a significant psychosocial impact of GDM on women, with systematic reviews estimating that women with GDM have a 30 to 60% higher risk of PPD compared to those without GDM. 8 , 9 PPD is a mood disorder that can impair maternal functioning and mother–child bonding. 10 The prevalence rate of postpartum depressive symptoms ranges from 7% to 17% in various studies. 9 , 11 , 12 , 13 , 14 These findings underscore the urgent need for comprehensive mental health support during pregnancy and postpartum.
Among women with recent GDM, immigration status may represent an important social determinant influencing the risk of postpartum depressive symptoms. A systematic review and meta‐analysis on PPD in immigrant women found an estimated prevalence of 20% for postpartum depressive symptoms in immigrant women, which was 2‐fold more common compared to non‐immigrant women. 15 Research by Noah et al. also found that immigrant status was associated with a higher risk of GDM compared to native‐born counterparts across all ethnic groups. 16 Further evaluation of time since immigration has revealed that recent immigrants (less than 5 years since arrival) have a lower risk of developing GDM compared to longer‐standing immigrants (5 years or more). 16 This is often attributed to the ‘healthy migrant effect,’ which diminishes over time due to sociocultural stressors. 17
Women with GDM represent a particularly vulnerable population, as they are at increased risk of both postpartum depressive symptoms and progression to type 2 diabetes. 18 The postpartum period is a critical window for implementing preventive lifestyle modifications; however, it is also characterized by competing demands and role transitions that may limit capacity for self‐care. 19 These challenges may be further exacerbated in immigrant populations due to factors such as cultural and linguistic barriers, reduced social support, financial instability and limited access to healthcare. 18 Within this context, increased vulnerability to PPD may further impair engagement in preventive behaviours, compounding the risk of adverse mental health outcomes and type 2 diabetes.
While associations between immigration status and GDM, as well as between immigration status and PPD, have been described, the role of immigration status in shaping PPD risk among women with GDM remains underexplored. Examining this relationship within a high‐risk population may help identify subgroups with compounded vulnerabilities and inform more targeted postpartum and diabetes prevention strategies.
In this cross‐sectional study of women with GDM in a postpartum diabetes prevention trial, 20 we sought to evaluate the association between immigration status and PPD symptoms based on a score of 10 or higher on the validated Edinburgh Postpartum Depression Scale (EPDS). 10 We also explored the impact of additional sociodemographic and clinical risk factors for PPD symptoms among this cohort.
2. METHODS
2.1. Study population, design and data sources
This cross‐sectional study was a secondary analysis of baseline data collected from the Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT‐M) clinical trial 20 (ClinicalTrials.gov Identifier: NCT01918345). ADAPT‐M recruited participants between March 2014 to March 2017 (Phase I) and September 2018 to January 2022 (Phase II) in Toronto, Ontario who received a diagnosis of GDM during their most recent pregnancy. The trial included participants aged 18 years and older, with sufficient English proficiency to provide informed consent and participate in study procedures, including telephone‐based health coaching sessions and interviewer‐administered questionnaires. 18 The ADAPT‐M trial received ethics approval from the Research Ethics Boards of Women's College Hospital and Sinai Health System.
Details are described elsewhere, 20 but briefly, participants were recruited during pregnancy and randomized between 3 and 9 months postpartum to standard care or one of three diabetes prevention health coaching programmes. Self‐reported and clinical data collected at their baseline study visit (3–9 months postpartum) were used for the current study. Data were collected from a baseline questionnaire that included sociodemographic questions and the EPDS tool.
2.2. Outcome
The primary outcome was the presence of postpartum depressive (PPD) symptoms, measured using the self‐reported Edinburgh Postnatal Depression Scale (EPDS). The EPDS is a validated 10‐item screening tool for perinatal depressive symptoms. A score of ≥10 is the recommended cutoff to identify individuals who may be experiencing clinically significant depressive symptoms and warrant further evaluation for postpartum depression. 21 In this study, we used an EPDS score of ≥10 to indicate clinically significant PPD symptoms. The EPDS was interviewer‐administered by a trained study coordinator as part of the baseline questionnaire, allowing for clarification of ambiguous items and ensuring complete responses. Patients with EPDS scores ≥10 or possible suicidal thoughts (question 10) were contacted by a registered nurse to assess the patient and provide a Mental Health referral if appropriate.
2.3. Exposure and covariates
The primary exposure was immigration status, categorized as self‐reported immigration to Canada or Canadian‐born. The secondary exposure included time since immigration, with participants subcategorized as recent immigrants (less than or equal to 10 years), long‐standing immigrants (more than 10 years) or Canadian‐born. Clinical covariates included age, body mass index (BMI), time since delivery; dichotomous variables such as dysglycaemia (defined as fasting glucose ≥6.0 mmol/L, 2‐h glucose ≥7.8 mmol/L or HbA1c ≥6.5%), number of live births (0–1 vs. 2+) and marital status; and categorical self‐reported variables including level of education, annual household income (tertiles) and ethnicity.
2.4. Statistical analyses
Descriptive statistics were used to summarize the demographic, clinical and socioeconomic characteristics of the participants, stratified by immigration status (immigrant vs. Canadian‐born). Categorical variables were reported as frequencies and percentages, while continuous variables were presented as medians with interquartile ranges (IQR) and/or as means with standard deviations (SD). For interaction analyses, ethnicity was dichotomized as Caucasian versus non‐Caucasian due to limited sample sizes within individual ethnic subgroups.
Univariate logistic regression analyses were performed to evaluate the association between PPD symptoms, defined as an EPDS score of ≥10 and immigration status, time since immigration and relevant clinical and sociodemographic factors. Multivariable logistic regression was then conducted to assess the independent association of immigration status with PPD while adjusting for relevant confounders, including age, BMI, dysglycaemia, number of live births, marital status, level of education and time since delivery (in months), household income and ethnicity.
A separate multivariable model was used to examine the relationship between time since immigration (≤ 10 years, >10 years) and PPD risk. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported for each variable and statistical significance was set at p < 0.05. Stratified analyses were performed to explore potential interactions between ethnicity (Caucasian vs. non‐Caucasian) and immigration status, as well as between annual household income and immigration status. Interaction terms between immigration status, ethnicity and household income were tested. All analyses were performed using SAS software v9.4 (SAS Institute Inc., Cary, NC, USA). This was a secondary analysis of an existing cohort; therefore, formal power calculations were not performed.
3. RESULTS
3.1. Patient demographic and clinical characteristics
A total of 327 women diagnosed with GDM during their most recent pregnancy who were a median of 4.0 months postpartum (IQR 1.6) were included in the analysis, of whom 195 (59.6%) were immigrants and 132 (40.4%) were Canadian‐born (Table 1). The median age at recruitment was comparable between groups, with immigrants at 36.0 years (IQR 6.2) and Canadian‐born participants at 36.6 years (IQR 5.8). Immigrant participants were more likely than Canadian‐born women to identify as South Asian (32.3%) or East‐Southeast Asian (27.2%), report an annual household income of <$60,000 CDN (18.4%) and have persistent dysglycaemia (40.0%). Canadian‐born women were more likely to report an annual household of >$100,000 CDN (56.1%). Other characteristics were largely similar between the groups (Table 1).
TABLE 1.
Demographic and clinical characteristics of randomized immigrant and canadian‐born participants with GDM.
| Description | Immigrant (N = 195) | Canadian‐born (N = 132) | Total (N = 327) |
|---|---|---|---|
| Age at recruitment (years), SD | |||
| Mean (SD) | 35.96 (4.68) | 36.43 (4.10) | 36.22 (4.45) |
| Median (IQR) | 35.76 (6.24) | 36.62 (5.76) | 36.25 (6.01) |
| BMI at baseline a (kg/m2) | |||
| ≤24.9 (underweight – normal weight) | 68 (34.87%) | 36 (27.27%) | 104 (31.80%) |
| 25.0–29.9 (overweight) | 52 (26.67%) | 30 (22.73%) | 82 (25.08%) |
| 30.0 + (obese) | 56 (28.72%) | 58 (43.94%) | 114 (34.86%) |
| Mean (SD) | 28.0 (5.93) | 29.92 (7.48) | 28.79 (6.67) |
| Median (IQR) | 26.69 (8.27) | 29.15 (9.19) | 27.30 (8.80) |
| Weight at baseline a (kg) | |||
| Mean (SD) | 70.88 (16.35) | 78.85 (22.54) | 74.18 (19.51) |
| Median (IQR) | 66.38 (21.35) | 75.88 (25.63) | 69.70 (23.91) |
| Time since delivery (months postpartum) b | |||
| Mean (SD) | 4.72 (2.35) | 4.83 (2.41) | 4.75 (2.37) |
| Median (IQR) | 4.0 (1.57) | 4.0 (2.06) | 4.0 (1.57) |
| Ethnicity, N (%) | |||
| Caucasian | 20 (10.26%) | 78 (59.09%) | 98 (29.97%) |
| South Asian | 63 (32.31%) | 10 (7.58%) | 73 (22.32%) |
| East‐Southeast Asian | 53 (27.18%) | 19 (14.39%) | 72 (22.02%) |
| African‐Caribbean | 22 (11.28%) | 12 (9.09%) | 34 (10.40%) |
| Other | 36 (18.46%) | 13 (9.85%) | 49 (14.98%) |
| Annual household income, N (%) | |||
| <$60,000 | 36 (18.46%) | 14 (10.61%) | 50 (15.29%) |
| $60,000–$100,000 | 45 (23.08%) | 28 (21.21%) | 73 (22.32%) |
| >$100,000 | 79 (40.51%) | 74 (56.06%) | 153 (46.79%) |
| Prefer not to answer | 35 (17.95%) | 16 (12.12%) | 51 (15.60%) |
| Highest level of education, N (%) | |||
| High school diploma | 7 (3.59%) | 1 (0.76%) | 8 (2.45%) |
| Undergraduate/College degree | 118 (60.51%) | 87 (65.91%) | 205 (62.69%) |
| Graduate/Professional/PhD | 70 (35.90%) | 44 (33.33%) | 114 (34.86%) |
| Number of live births, N (%) | |||
| 0–1 | 155 (79.49%) | 115 (87.12%) | 270 (82.57%) |
| 2+ | 40 (20.51%) | 17 (12.88%) | 57 (17.43%) |
| Marital status, N (%) | |||
| Married | 188 (96.41%) | 125 (94.70%) | 313 (95.72%) |
| Unmarried | 7 (3.59%) | 7 (5.30%) | 14 (4.28%) |
| Dysglycaemia | 76 (38.97%) | 21 (15.91%) | 97 (29.66%) |
| Fasting glucose (mmol/L) | |||
| Mean (SD) | 5.0 (0.66) | 4.99 (0.53) | 4.99 (0.61) |
| Median (IQR) | 4.90 (0.80) | 4.90 (0.70) | 4.90 (0.73) |
| 2‐H Glucose (mmol/L) | |||
| Mean (SD) | 7.40 (2.25) | 6.31 (1.98) | 6.95 (2.10) |
| Median (IQR) | 7.0 (2.63) | 6.10 (2.0) | 14.57 (2.50) |
| HbA1c (%) | |||
| Mean (SD) | 5.4 (0.4) | 5.4 (0.4) | 5.4 (0.4) |
| Median (IQR) | 5.4 (0.4) | 5.3 (0.5) | 5.4 (0.4) |
Note: Denominator includes those with missing data.
Abbreviations: Dysglycaemia, fasting glucose ≥6.0 mmol/L, 120‐min glucose ≥7.8 mmol/L or A1c ≥ 6.5%; HbA1c, Haemoglobin A1c; N, number; SD, standard deviation.
Baseline = 3–12 months postpartum.
From actual delivery date to randomization date.
3.2. Association between immigrant status and PPD symptoms
Among the 327 participants, PPD symptoms, defined as an EPDS score of ≥10, were observed in 74 women (22.6%). The prevalence of PPD symptoms was 25.6% for immigrant women compared to 18.2% for Canadian‐born women. Immigrant women had higher odds of PPD symptoms compared to Canadian‐born women, but the association did not reach statistical significance (odds ratio, OR 1.56, 95% CI 0.90, 2.70). There was no significant interaction between immigrant status and ethnicity and household income. Therefore, those and other relevant variables (age, BMI, dysglycaemia, number of live births, marital status, level of education, time since delivery) were included in the multivariable model, which showed no significant association between immigrant status and PPD symptoms (adjusted, AOR 1.01, 95% CI 0.50, 2.03). There was no significant effect of time since immigration (Table 2).
TABLE 2.
The association between immigrant status, categorized as time since immigration and PPD symptoms.
| Description | Total, N (%) | PPD symptoms, N (%) | Univariate OR (95% CI) | Adjusted a OR (95% CI) |
|---|---|---|---|---|
| Overall | 327 (100%) | 74 (22.63%) | NA | NA |
| Immigration status b | ||||
| Immigrant | 195 (59.63%) | 50 (25.64%) | 1.56 (0.90–2.70) | 1.01 (0.50–2.03) |
| Canadian‐born | 132 (40.37%) | 24 (18.18%) | 1.0 | 1.0 |
| Time since immigration (years) b | ||||
| Canadian‐born | 132 (40.37%) | 24 (18.18%) | 1.0 | 1.0 |
| ≤10 | 57 (17.43%) | 16 (28.07%) | 1.76 (0.85–3.64) | 1.18 (0.52–2.68) |
| >10 | 79 (24.16%) | 19 (24.05%) | 1.43 (0.72–2.81) | 1.11 (0.52–2.40) |
Abbreviations: N, number; NA, not applicable; OR, odds ratio; PPD, postpartum depressive symptoms, based on an Edinburgh Postpartum Depression Scale (EPDS) score of ≥10.
Adjusted for age, BMI, dysglycaemia, number of live births, marital status, level of education, time since delivery, ethnicity and household income.
Denominator includes those with missing data; compared to Canadian‐born.
3.3. Association between covariates and PPD symptoms
Self‐reported annual household income was significantly associated with PPD symptoms; there were no other significant associations (Figure 1). Women with low annual household income (<C$60,000) were significantly more likely to report PPD symptoms compared to those with income >C$100,000 (AOR 3.71, 95% CI 1.61, 8.56). Among women with low income, the prevalence of PPD symptoms was 48%, with PPD symptoms reported in 52.8% of immigrant women and 35.7% of Canadian‐born women. A significant interaction was observed between immigration status and household income (p = 0.0397), whereas no significant interaction was observed with ethnicity (p = 0.80) (Table S1).
FIGURE 1.
Sociodemographic and clinical predictors of postpartum depression (PPD) symptoms among women with recent gestational diabetes mellitus (GDM). Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are shown for each characteristic. ORs were adjusted for age, BMI, dysglycaemia, number of live births, marital status, education, time since delivery, ethnicity and household income. Error bars represent 95% CIs. Reference categories are indicated (OR = 1.00). The x‐axis is displayed on a logarithmic scale.
4. DISCUSSION
This cross‐sectional study of women with recent GDM demonstrated that PPD symptoms are common in this population in the early postpartum period. While we did not show a significant difference in PPD symptoms among immigrant women, one in four had a high PPD screening score. In addition, we found that almost 50% of patients reporting an annual household income in the lowest tertile had PPD symptoms, with an estimated fourfold higher risk compared to those in the highest tertile. Of note, 53% of low‐income immigrant women had a high PPD screening score, highlighting a particularly vulnerable group that warrants further attention. These findings highlight how intersecting social determinants influence mental health during a vulnerable period in a woman's life. This is particularly relevant for women with recent GDM given the known link between untreated PPD and poor adherence to lifestyle interventions necessary for diabetes prevention. 22 , 23
While the prevalence of PPD symptoms was higher among immigrant women with recent GDM, the absence of significant findings may be attributed to insufficient statistical power resulting from the relatively small sample size. A systematic review and meta‐analysis by Falah‐Hassani et al. found that immigrant women are twice as likely to experience postpartum depressive symptoms compared to non‐immigrant women, supporting a significant association in larger populations. 15 These findings may also be due to the heterogeneity of immigrant populations, with effects dependent on region of origin or other factors. A meta‐analysis by Anderson et al. reported varying associations between migrant status and PPD across countries. 24 In Canada, migrant status was associated with higher PPD risk (OR 1.98, 95% CI 1.57–2.49), whereas studies from the United States and Australia found no such association. 24 These inconsistencies likely reflect differences in sociocultural and healthcare contexts. 25 Immigration status alone is unlikely to predict PPD risk, as immigrant women represent a diverse group with varying socioeconomic, cultural, genetic and environmental profiles. Factors such as socioeconomic status, minority ethnicity, social support networks, cultural adaptation and length of residence have been shown to differentially influence PPD risk within this population. 24 , 25 This heterogeneity suggests that not all immigrant women share the same level of risk, which could have obscured potential associations in our analysis. We were not able to examine differences by region of origin due to our small sample. Future studies with larger sample sizes and more detailed stratification of immigration‐related factors are needed to better understand these complex relationships.
While previous literature has described a ‘healthy migrant effect’ that may provide temporary health advantages to recent immigrants, 15 our findings did not reveal significant variations in PPD risk based on time since immigration. Immigrants who had lived in Canada for more than 10 years showed a similar prevalence of PPD symptoms compared to more recent arrivals. Previous studies that examined health outcomes such as mortality, self‐rated health, mental health and chronic conditions have shown better health outcomes in recent immigrants to Canada, with health status converging with that of native‐born populations over 10–20 years. 15 , 17 This may reflect the enduring impact of systemic and structural inequities, including cultural stigmatization of mental health, linguistic and social isolation and persistent barriers to accessing healthcare, regardless of length of residency. 17
Our study identified that low household income was a significant predictor of PPD symptoms in both immigrant and Canadian‐born women with GDM, with the highest prevalence among low‐income immigrant women. Our results agree with a systematic review of this population where low socioeconomic status was reported to be a risk factor for PPD in immigrant women. 15 The high rate of PPD symptoms in low‐income immigrant women highlights the importance of an intersectional approach. Immigrant women from low‐income households may have compounded mental health risks in the postpartum period. Factors such as unemployment and underemployment, food insecurity, low income, lack of social support, cultural and language barriers, lower mental health functioning and challenges adapting to a new country can contribute to this increased risk. 15 , 26 , 27 Further studies are needed to identify additional risk factors contributing to PPD in immigrant women with GDM and to better understand the complex interplay of social determinants of health in GDM care.
Postpartum lifestyle guidelines and screening are crucial for preventing PPD and the progression of GDM to type 2 diabetes. The Canadian Task Force on Preventive Health Care advises PPD screening for high‐risk individuals. 28 Diabetes Canada recommends a 75 g oral glucose tolerance test within 6 weeks to 6 months postpartum and lifestyle counselling for all women with GDM. 19 A large RCT by Crowther et al. found that women with GDM who received dietary counselling, glucose monitoring and insulin therapy had a significantly lower incidence of PPD at 3 months postpartum (8% vs. 17%), suggesting a protective effect of healthy behaviour counselling. 11 However, despite these recommendations and the proven benefit of lifestyle counselling, few postpartum programmes currently exist for lifestyle counselling for women with GDM. Moreover, even when such programmes are offered, immigrant women may be less likely to access them compared to their native‐born counterparts. Immigrant women with GDM may face additional barriers, such as language difficulties, cultural stigma and socioeconomic challenges, limiting their engagement with these programmes. Furthermore, studies indicate that immigrant women are less likely to access PPD screening, with key barriers including shorter length of residence, cultural stigma, language proficiency and family obligations. 12 Research on immigrant mothers and their families has found that in many cultures, mental illnesses like PPD are often associated with shame. 13 , 14 Teng et al. found that all healthcare providers in their study cohort cited language barriers as a major obstacle to postpartum care access. 29 Interventions designed to prevent type 2 diabetes postpartum need to consider unique challenges regarding coexisting mental health barriers among immigrant women. Targeted interventions, such as peer navigators that can communicate in participants' native languages, culturally adapted outreach and family and community‐inclusive programmes for enhanced social support, may improve mental health and diabetes management in this population. 30
This is the first study to our knowledge to investigate the intersection between GDM, immigration status and PPD symptoms. Although the increased risk of PPD among women with GDM is well established, the role of immigration status within this population remains underexplored. A diverse, well‐characterized cohort strengthens generalizability. However, several limitations warrant consideration. The small sample size may have limited the power to detect smaller but clinically meaningful associations. The immigrant cohort in this study was predominantly composed of South Asian and East‐Southeast Asian women, populations known to differ in metabolic risk profiles, body composition and dietary patterns. These differences, including a tendency toward lower BMI despite higher metabolic risk in some groups, may have influenced both GDM severity and postpartum outcomes and could have contributed to the observed associations. Given the sample size, ethnicity was dichotomized as Caucasian versus non‐Caucasian for interaction analyses, which may have obscured differences across specific ethnic groups. These findings should also be interpreted within the Canadian healthcare and sociocultural context, characterized by a publicly funded healthcare system and a diverse immigrant population with varying access to care and social supports. Differences in healthcare access, immigration patterns, and socioeconomic structures across countries may limit the generalizability of these results to other settings. Additionally, the inclusion of only English‐speaking participants may limit the generalizability of our findings, as immigrant women with limited English proficiency may face greater barriers to care, increased social isolation, and a higher risk of postpartum depressive symptoms. 15 , 29 Furthermore, reliance on self‐reported income and the dichotomization of immigration duration may have obscured more granular trends. Finally, while data on general medical history were collected, we did not specifically record the presence of antepartum or pre‐existing mental health conditions, which may have contributed to residual confounding. Longitudinal studies are needed to better understand how psychosocial factors interact with diabetes prevention efforts in the critical postpartum window.
5. CONCLUSION
Postpartum depressive symptoms are common among women with recent GDM, particularly among those with a low household income. Our findings highlight the need to prioritize PPD screening in women with recent GDM and to tailor follow‐up care by considering social determinants of health, such as income and immigration status. While the prevalence of PPD symptoms was not significantly higher for immigrant women, further studies are needed to identify high‐risk subgroups.
AUTHOR CONTRIBUTIONS
Nilah Ahimsadasan contributed to the study concept and design, drafted and edited the manuscript, and created the figures and tables. Lorraine L. Lipscombe contributed to the study concept and design, provided grant support and supervision, and co‐wrote the manuscript. Wei Wu contributed to the analytic plan and methods and data analysis. Diana Sherifali contributed to the study concept and editing of the manuscript. Ishraq Rahman contributed to recruitment, data collection, data management and editing of the manuscript.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
Supporting information
Table S1. Stratified analyses of ethnicity and household income by immigration status in relation to postpartum depressive symptoms.
ACKNOWLEDGEMENTS
This research is a secondary analysis of baseline data from the Ontario diabetes prevention clinical trial, Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT‐M), Trial ID NCT01918345, which was funded by a Project Grant from the Canadian Institutes for Health Research (CIHR), Reference number: PJT‐153192. The analyses, conclusions, opinions, and statements expressed herein are those of the authors and do not reflect those of the funders.
Ahimsadasan N, Wu W, Rahman I, Sherifali D, Lipscombe LL, . The risk of postpartum depressive symptoms in immigrant women with recent gestational diabetes mellitus. Diabet Med. 2026;43:e70339. doi: 10.1111/dme.70339
[Correction added on 29 May 2026 after first online publication: The names of the steering committee have been listed under the first‐page footnote in this version.]
Contributor Information
Lorraine L. Lipscombe, Email: lorraine.lipscombe@wchospital.ca.
the ADAPT‐M steering committee:
Kevin Thorpe, Jennifer Price, Howard Berger, Denice Feig, Karen Fleming, Ilana Halperin, Paula Harvey, Geetha Mukerji, Joel Ray, Ravi Retnakaran, and Afshan Zahedi
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Supplementary Materials
Table S1. Stratified analyses of ethnicity and household income by immigration status in relation to postpartum depressive symptoms.