Author:
Ohene-Agyei Phyllis,Tran Thach,Harding Jane E.,Crowther Caroline A.
Abstract
Abstract
Background
Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes.
Methods
This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets.
Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach.
Results
We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks’ (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks’ [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)].
Conclusion
We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks’ gestation and at 6 months postpartum.
Trial registration
The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR—Registration). Date of registration: 25 March 2015.
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology
Reference62 articles.
1. World Health Organization. Global report on diabetes. Geneva: WHO Press; 2016. Available from: http://www.who.int
2. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. Available from: https://doi.org/10.1016/j.diabres.2018.02.023
3. Ministry of Health. Screening, Diagnosis and Management of Gestational Diabetes in New Zealand: a clinical practice guideline. Wellington; 2014 [cited 2021 Jun 29]. Available from: www.health.govt.nz
4. Lavery JA, Friedman AM, Keyes KM, Wright JD, Ananth CV. Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017 Apr 1 [cited 2022 Apr 30];124(5):804–13. Available from: /pmc/articles/PMC5303559/
5. Miller NE, Curry E, Laabs SB, Manhas M, Angstman K. Impact of gestational diabetes diagnosis on concurrent depression in pregnancy. J Psychosom Obstet Gynecol. 2021 [cited 2022 Jul 1];42(3):190–3. Available from: https://www-tandfonline-com.ezproxy.auckland.ac.nz/doi/abs/10.1080/0167482X.2019.1709816