Mental Health and Metabolic Outcomes in Early Postpartum in Women with Prediabetes After Gestational Diabetes: A Secondary Analysis of the MELINDA Trial

Abstract

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized controlled trial (MELINDA), evaluating a mobile-based lifestyle intervention versus standard follow-up (control group) in women with prediabetes after GDM. The analysis included 166 participants who completed the Center for Epidemiologic Studies-Depression (CES-D) questionnaire [score of ≥16 being suggestive for (sub)clinical depression] at baseline (6-16 weeks postpartum) and one year post-randomization. Results: At one year, 26.5% of women (n = 44) reported depressive symptoms, with no significant difference between the intervention and control groups (30.5% vs. 22.6%, p = 0.293). Women with depressive symptoms (symptomatic women) were younger (30.9 ± 4.9 vs. 32.5 ± 3.8 years, p = 0.033) and were less often highly educated (61.4% vs. 80.3%, p = 0.028). At baseline, symptomatic women had a higher rate of metabolic syndrome (38.6% vs. 21.9%, p = 0.044), higher LDL-cholesterol [3.2 ± 0.8 vs. 2.8 ± 0.8 mmol/L, p = 0.009], lower quality of life (lower SF-36 scores, p < 0.050) and a higher level of anxiety based on the STAI-6 questionnaire (14.5 ± 3.6 vs. 11.2 ± 2.6, p < 0.001). These differences persisted at one year postpartum with worse metabolic profile, more anxiety and lower quality of life in symptomatic women. Conclusions: Depressive symptoms are common in women with prediabetes in early postpartum after GDM and are associated with a persistent worse metabolic profile, increased anxiety and lower quality of life postpartum. The mobile-based lifestyle intervention did not improve mental health.

Keywords: depression; gestational diabetes mellitus; glucose intolerance; mental health; metabolic profile; type 2 diabetes.

Figure 1

Flowchart of participants of the MELINDA study. MELINDA, Eligible participants were randomly assigned in a 1:1 ratio to either a one-year blended-care mobile-based lifestyle program (intervention) or usual care (control); RCT, randomized controlled trial; NGT, normal glucose tolerance; OGTT, oral glucose tolerance test.

Figure 2

Flowchart of participants included in the secondary analysis. RCT, randomized controlled trial; CES-D questionnaire; Cener for Epidemiologic Studies-Depression questionnaire; NS, no symptoms of depression; S, symptoms of depression.

Figure 3

Overall change in the prevalence of depressive symptoms between baseline and one year postpartum. NS, no symptoms of depression, S symptoms of depression. The McNemar test was used for the analysis of paired binary data. Differences are considered significant at p-value < 0.05. One participant did not complete the CES-D questionnaire at either baseline or one year postpartum, resulting in missing data for that individual.