Low-income diabetic women at increased risk for postpartum depression

Researchers at Harvard Medical School (HMS) and the University of Minnesota have found that living just above the poverty line and having diabetes increases by 50 percent a woman’s chance of developing postpartum depression — a serious illness that affects about one in 10 new mothers.

“While previous studies have linked diabetes and depression in the general population, this is the first time, to our knowledge, that the relationship has been studied specifically in pregnant women and new mothers,” says Katy Backes Kozhimannil, research fellow in the Department of Ambulatory Care and Prevention at HMS and Harvard Pilgrim Health Care. “We believe these findings may help clinicians better identify and treat depression in new mothers.”

These findings were published in the Feb. 25 issue of JAMA, the Journal of the American Medical Association.

For more than 25 years, clinicians have been aware that new mothers are at risk for postpartum depression. However, the condition is difficult to identify. Many symptoms are attributed to the everyday struggles of being a new mother. Others, such as irrational thoughts about harming the baby or, conversely, obsessing over the baby’s health, are simply difficult for new mothers to admit.

To investigate the potential link between diabetes and postpartum depression, Kozhimannil and Bernard Harlow, professor in the University of Minnesota’s School of Public Health, examined medical claims data from the New Jersey Medicaid program, looking at information from 11,024 new mothers who had given birth between July 2004 and September 2006.

The researchers identified a woman as having depression if her records indicated a diagnosis, or if she had filled a prescription for an antidepressant medication during the study period. (Diabetes was also identified using both diagnosis and prescription information.)

Study data indicated that 9.6 percent of women with diabetes, who had no indication of depression during pregnancy, developed depression during the year following delivery, compared with 5.9 percent of women without diabetes. Put another way, pregnant women and new mothers with diabetes were approximately 55 percent to 60 percent more likely to experience postpartum depression. The researchers caution that these findings do not establish that diabetes causes postpartum depression, only that there appears to be an as yet unexplained link between the two. Also, the medical claims data they used did not contain information on personal or family history of depression, weight, or body mass index. Plus, it isn’t yet clear the extent to which one can generalize findings from such a specific and localized population.

Still, according to Kozhimannil, “health care facilities and clinicians that serve low-income and Medicaid populations may want to pay particular attention to managing the mental health concerns of women with diabetes during pregnancy and the postpartum period.”