King's College London

Is gestational diabetes associated with adverse maternal and child mental health outcomes?

Gestational diabetes mellitus (GDM) is defined as ‘glucose intolerance with onset during pregnancy’, has a UK prevalence of between five and 10% and is associated with adverse outcomes for mother and baby.

These adverse outcomes include obstetric complications and an increased risk of subsequent Type 2 diabetes in 60% of mothers. Adverse neuro-behavioural outcomes have also been observed in the child, which appear to be inversely correlated with level of glycaemic control and include inattention and hyperactivity and lower verbal IQ scores

Mental disorders and diabetes

Mental disorder is the most common morbidity of the perinatal period. One in five women develop a mental disorder during pregnancy or in the year following birth, with associated adverse maternal and fetal outcomes and emotional and behavioural problems in the child. The outcomes in children from mothers experiencing GDM with co-occurring mental disorder have not been studied.

Recent research suggests that the prevalence of depression in the general diabetic population is twice that of the non-diabetic population, with some research showing an association between depression and both treatment non-adherence and poorer glycaemic control. Given that Type 2 diabetes and GDM share the same pathophysiology of insulin resistance, a study of the relationship between GDM and mental disorder and the influence of mental disorder on future risk of Type 2 diabetes following GDM is timely. Existing literature finds cross-sectional associations between GDM and mental disorder using screening tools up to four months following childbirth. However, the extent of the risk for mental disorder in those with GDM, subsequent maternal and child health outcomes and underlying mechanisms are unclear.

Project aims

This study aims to establish the extent to which gestational diabetes mellitus (GDM) is associated with adverse maternal mental health outcomes and whether mental disorder in those with GDM is associated with subsequent development of Type 2 diabetes and adverse child neuro-behavioural outcomes.

How the study will be carried out

This study is funded by the MRC Clinical Research Training Fellowship supervised by Professor Louise Howard, Professor Khalida Ismail and Professor Emily Simonoff at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.

It will be divided into individual substudies:

• Study 1a- a systematic review and meta-analysis of prevalence and odds of perinatal mental disorder in women with GDM.
• Study 1b- risk for perinatal mental disorder in women with GDM will be assessed from a questionnaire about mental symptoms and diagnoses from primary care records.
• Study 2- future risk of Type 2 diabetes in women with GDM and antenatal mental disorder will be investigated using primary care diagnoses of Type 2 diabetes.
• Study 3- neuro-behavioural outcomes of children whose mothers had GDM and antenatal mental disorder will be investigated using two measures of the child’s development at ages four and seven.

The research team will collaborate with Bradford Institute for Health Research (Professor John Wright and the Born in Bradford cohort study team) and the University of Edinburgh (Professor Rebecca Reynolds, Centre for Cardiovascular Science),

Two patient and public involvement groups were involved in the proposal's development and continue to inform the direction of the project:

• King’s College London’s Section of Women's Mental Health Service User Advisory Group
• Born in Bradford Parent Governors' Group

Potential benefits of the research to people in south London

Exploring the relationships between GDM and mental disorder and potential mechanisms for the associations will help inform tailoring of healthcare interventions for women with GDM to better support their needs and improve longer-term health outcomes for women and their children.

The study was adopted by ARC South London and will be completed by August 2020.

Project lead

Dr Claire Wilson

MRC Clinical Research Training Fellow