Table 4.
Summary of data provided by each study and effect estimates for high levels of postnatal depressive symptoms
| Author and year | Sample size | Mental disorder measure and time | GDM measure | Ethnicity | Pre‐pregnancy BMI (kg/m2) | Risk of bias | Prevalence of depression in GDM group (%) | Unadjusted OR (95% CI) |
|---|---|---|---|---|---|---|---|---|
| Al‐Shahrani et al., 2011 | 113 |
EPDS ≥12 1 week postpartum |
75 g OGTT | Saudi Arabia (ethnicity unspecified) | Unavailable | High | 41.1† | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Beka et al., 2018 | 326 723 |
ICD‐9 and ‐10 Up to 1 year postpartum |
Diagnostic codes 24–28 weeks gestation |
Aboriginal: 5.9% Chinese: 3% South Asian: 8.5% ‘General population’: 82.6% |
Underweight (≤ 45kg) 0.6% Overweight (≥ 91kg) 8.6% |
Low to moderate | 13.1† | 1.06* (1.00–1.11) |
| Bener et al., 2012 | 1379 | EPDS ≥12 Within 6 months of delivery | Not specified | Qatar (ethnicity unspecified) | Unavailable | High | 25.5† | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Berger et al., 2015 | 537 | EPDS ≥13 Between day 0 and day 4 postpartum | Not specified |
Caucasian: 63.6–71.1% African American: 5.5–9.1% Other: 22.5–29.7% |
Mean (sd) From 25.7 (6.0) to 27.6 (8.6) in different subgroups |
High | 9.7* | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Besser et al., 2007 | 209 |
CES‐D ≥ 16 8 weeks' postpartum |
50 g OGTT 24–28 weeks' gestation Two abnormal OGTT (at 1 and 3 h) |
Israel (ethnicity unspecified) | Unavailable | Low to moderate | 47† | 1.31* (0.76–2.27) |
| Blom et al., 2010 | 4941 |
EPDS ≥ 13 Two months postpartum |
Midwife and hospital registries Dutch midwifery and obstetric guidelines: random glucose > 11.1 mmol/l or fasting > 7.0 mmol/l |
Dutch: 62.9% Other Western: 18.7% Non‐Western: 18.4% |
Unavailable | Low to moderate | 12.5† | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Clark et al., 2019 | 766 |
DSM‐IV major depressive disorder, atypical depressive disorder or depressive disorder not otherwise specified Up to 6 months postpartum |
1‐h 75 g OGTT: 7.8 mmol/l 1‐h 100 g OGTT: 10 mmol/l 2‐h 100 g OGTT: 8.45 mmol/l Fasting glucose: 5.1 mmol/l |
Caucasian: 40.2% Hispanic: 15.7% African American: 4.5% Asian: 36.8% Native American: 2.8% |
Unavailable | Low to moderate | 7.9* | 0.94 (0.56–1.58)* |
| Farr et al., 2014 | 4451 | Self‐report but validated against diagnostic interview ‘in the postpartum' | Self‐report | USA (unable to calculate) | Unable to calculate | Low to moderate | 10.9* | Only adjusted estimates provided |
| Ferrari et al., 2018 | 173 |
BDI‐I ≥10 and BDI‐II ≥14 Up to 1 year postpartum |
OGTT and IADPSG criteria Any one of: Fasting plasma glucose ≥5.1 mmol/l 1‐h post 75 g OGTT ≥10.0 mmol/l 2‐h post 75 g OGTT ≥8.5 mmol/l |
Germany (ethnicity unspecified) |
NB in postpartum Mean (sd) No depressive symptoms: 25.5 (5.9) Mild/moderate depressive symptoms 29.2 (7.7) |
High | 12.7† | Unavailable |
| Gunderson et al., 2015 | 1035 |
CES‐D ≥16 6–9 weeks postpartum |
Carpenter–Coustan criteria On 3‐h 100g OGTT, two or more of: Fasting ≥ 5.3 mmol/l 1 h ≥ 10 mmol/l 2 h ≥ 8.6 mmol/l 3 h ≥ 7.8 mmol/l |
Non‐Hispanic White: 15–24.6% Non‐Hispanic Black: 7–11.5% Hispanic: 29–40.7% Asian: 31.9–37.4% Other: 0.9–2% |
Mean (sd) 29 (6.9) to 33.4 (8.3 |
Low to moderate | 13.2† | Unavailable |
| Hinkle et al., 2016 | 2802 | EPDS ≥10 at 6 weeks postpartum or self‐reported antidepressant medication use in postpartum |
Medical records Carpenter–Coustan criteria On 3‐h 100 g OGTT, two or more of: Fasting ≥5.3 mmol/l 1‐h ≥ 10 mmol/l 2‐h ≥ 8.6 mmol/l 3‐h ≥ 7.8 mmol/l |
Non‐Hispanic White: 28% Non‐Hispanic Black: 27.6% Hispanic: 28.8% Asian: 15.6% |
Normal weight: 56.4% Overweight: 26.3% Obese 17.3% |
High | 14.8† | 4.52† (1.23–16.69) |
| Huang et al., 2015 | 2112 |
EPDS ≥13 6 months postpartum |
1‐h 50 g non‐fasting glucose challenge test (GCT) and if > 140 mg/dl, then 3‐h 100 g fasting OGTT according to ADA criteria |
(Percentages across categories of depression) White: 50–72% Black: 13–24% Hispanic: 6–14% Asian: 4–7% Other: 4–7% |
(Percentages across categories of depression) Underweight (< 18.5): 3–6% Normal (18.5 to < 25): 50–61% Overweight (25 to < 30): 20–26% Obese (≥ 30): 14–25% |
High | 11† | 1.45† (0.71–2.99) (age adjusted) |
| Katon et al., 2014 | 1319 |
PHQ‐9 ≥ 10 6 weeks postpartum |
ICD‐9 GDM (648.8) from medical records |
White: 73.8% African American: 5.6% Hispanic: 4.6% Other: 16.0% |
Unavailable | Low to moderate | 5.4† | 1.02* (0.57‐1.8) |
| Kim et al., 2005 | 1445 |
Short form CES‐D 10 items ≥ 11 8–12 weeks postpartum |
Medical records |
Latina: GDM 50%, control 34.7% White: GDM 25%, control 34.1% African American: GDM 17.2%, control 16.6% Other: GDM 7.8%, control 14.6% |
Normal/underweight (< 25): GDM 34.4%, control 62.5% Overweight (25–29.9): GDM 20.3%, control 22.6% Obese (≥30): GDM 45.3%, control 14.9% |
Low to moderate | 14.1* | Unavailable |
| Koutra et al., 2016 | 1037 |
EPDS ≥13 8 weeks postpartum |
3‐h 100 g OGTT Carpenter–Coustan criteria Fasting ≥ 5.3 mmol/l 1‐h ≥ 10 mmol/l 2‐h ≥ 8.6 mmol/l 3‐h ≥ 7.8 mmol/l |
Greek: 93% Other: 7% |
Mean (sd) EPDS < 13 24.16 (4.87) EPDS ≥13 24.18 (4.76) |
Low to moderate | 18.4† | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Kumpulainen et al., 2018 | 3215 |
CES‐D ≥ 16 2 and/or 28 weeks postpartum |
Medical records 75 g OGTT fasting ≥ 5.1, 1 h 10.0 or 2 h 8.5 mmol/l |
Finland (ethnicity unspecified) |
In early pregnancy‐Underweight (<18.5): 3.3% Normal 18.5–24.99): 63.9% Overweight (25–29.99): 19.6% Obese (≥ 30): 13.3% |
Low to moderate | 20.9‡ | 1.13‡ (0.86–1.49) |
| Mautner et al., 2009 | 40 |
EPDS ≥ 10 3–4 months postpartum |
Medical records | Austria (ethnicity unspecified) | Unavailable | High | 27.3‡ | 1.8‡ (0.35–9.28) |
| Natasha et al., 2018 | 734 |
MADRS ≥ 13 Within 1 week postpartum |
Plasma glucose ≥ 7.0 (WHO criteria) or ≥ 5.3 mmol/l at fasting and ≥ 8.6 mmol/l at 2‐h post 75 g OGTT (ACOG criteria) | Bangladesh (ethnicity unspecified) | Unavailable | Low to moderate | 12.8† | 3.39† (1.86–6.17) |
| Nehbandani et al., 2016 | 262 |
EPDS ≥12 4–6 weeks postpartum |
At least one abnormal result on 2‐h 75 g OGTT: fasting ≥ 92 mg/dl (5.1 mmol/l) 1‐h ≥ 180 mg/dl (10 mmol/l) 2‐h ≥ 153 mg/dl (8.5 mmol/l) |
Iran (ethnicity unspecified) | Unavailable | High | 34.3† | 2.21* (1.25–3.89) |
| Nicklas et al., 2013 | 71 |
EPDS ≥9 4–15 weeks postpartum |
Carpenter–Coustan criteria On 3‐h 100g OGTT, two or more of: Fasting ≥ 5.3 mmol/l 1 h ≥ 10 mmol/l 2 h ≥8 .6 mmol/l 3 h ≥ 7.8 mmol/l |
African American: 28% Asian: 13% Hispanic: 21% Non‐Hispanic White: 38% |
Mean 30 | High | 33.8† | Unavailable |
| O'Reilly et al., 2016 | 573 |
PHQ‐9 ≥ 10 3 months postpartum |
ADIPS criteria One or more: Fasting plasma glucose ≥5.1 mmol/l 1‐h post 75 g OGTT ≥ 10.0 mmol/l 2‐h post 75 g OGTT ≥ 8.5 mmol/l |
Africa: 3.5% Americas: 0.7% Asia: 38.9% Europe: 29% Oceania: 1.2% Australia and New Zealand: 22.9% Aboriginal and Torres Strait Islander: 0.2% |
Mean (sd) 28.8 (6.8) Postnatal baseline |
Low to moderate | 10.4† | Unavailable |
| Ruohomäki et al., 2018 | 1066 |
EPDS ≥ 10 8 weeks postpartum |
Medical records Finnish current care guidelines: 75 g OGTT with at least one abnormal value ≥ 5.3 mmol/l for fasting stage, ≥10.0 mmol/l at 1 h and ≥ 8.6 mmol/l at 2 h= | Finnish (ethnicity unspecified) |
Mean (sd) No GDM: 24.1 (4.3) GDM: 28.7 (6.5) |
High | Unavailable | 1.84† (1.13–3.00) |
| Silverman et al., 2017 | 701 404 |
ICD‐9 and ‐10 Up to 1 year postpartum |
Birth registers | Sweden (ethnicity unspecified) | Unavailable | High | 1.4† | 2.3* (1.72–3.09) |
| Varela et al., 2017 | 93 |
EPDS ≥ 13 1 week postpartum |
Self‐report (not reported in paper but information provided by study author) | Greek: 97.8% | Unavailable | High | 35.7† | 4.32† (1.18–15.78) |
| Walmer et al., 2015 | 18 888 | ICD‐9 ‘in the postpartum’ |
1‐h 50 g glucose load test ≥ 7.8 and 3‐h 100 g OGTT Carpenter–Coustan criteria On 3‐h 100g OGTT, two or more of: Fasting ≥ 5.3 mmol/l 1 h ≥ 10 mmol/l 2 h ≥ 8.6 mmol/l 3 h ≥ 7.8 mmol/l |
Asian: 7.2% Black: 5.8% Hispanic: 25.7% White: 61.3% |
Mean (sd) From first antenatal visit GDM: 29 (7.2) No GDM: 25.3 (5.2) |
Low to moderate | Unavailable | 1.45† (1.15–1.82) (age adjusted) |
| Youn et al., 2017 | 1 269 130 |
ICD‐10 Up to 1 year postpartum |
ICD‐10 codes | South Korea (ethnicity unspecified) | Unavailable | High | 3.9† | Not used for meta‐analysis as unclear if pre‐GDM excluded |
| Zwolinska‐Kloc et al., 2017 | 70 |
MINI diagnostic interview ICD‐10 6–7 months postpartum |
OGTT 24–28 weeks gestation (not reported in paper but information provided by study author) |
Poland (ethnicity unspecified) | Unavailable | High | 8.6† | 7.65* (0.38 153.76) |
| Median prevalence 13.1% (IQR 10.4–25.5%) | ||||||||
| Pooled OR 1.59 (95% CI 1.26, 2.00) | ||||||||
*Derived from data in paper. †Estimate given in paper. ‡Data provided by study author.
ADIPS, Australasian Diabetes in Pregnancy Society; BDI, Beck Depression Inventory; CES‐D, Center for Epidemiological Studies‐Depression; DSM‐IV, Diagnostic and Statistical Manual of Mental Disorders‐IV; EPDS, Edinburgh Postnatal Depression Scale; IADPSG, International Association of Diabetes and Pregnancy Study Groups; MADRS, Montgomery–Åsberg Depression Rating Scale; OGTT, oral glucose tolerance test; PHQ‐9, Patient Health Questionnaire‐9.