Associations between prenatal diabetes mellitus, social determinants of health, and postpartum psychopathology: A retrospective review within women with diabetes mellitus

Background We examine associations between pregestational Type 1 or Type 2 diabetes mellitus (PGDM) versus gestational diabetes mellitus (GDM) with postpartum psychopathology. Methods We collected demographics, social determinants of health, medical comorbidities, psychiatric history, and postpartum psychiatric diagnoses at an urban, academic hospital from 9/2020-12/2023. Outcomes across patients with GDM and PGDM were compared with chi-square, t-tests, and multivariable logistic regression. Results Of 6,186 pregnancies, 111 (3%) experienced PGDM and 871 (23%) GDM. Patients with PGDM showed higher rates of cesarean delivery [X ² (1) = 9.30, p < 0.01], NICU stay [X ² (1) = 21.65, p < 0.0001], and MICU stay [X ² (1) = 7.05, p < 0.01] and higher maximum HbA1c values [7.14 +/- 1.67 mmol/mol versus 6.18 +/- 1.49 mmol/mol; t(304) = 9.92, p < 0.01] as compared to those with GDM. Low social connections, a measured social determinant of health, was higher for patients with GDM (X ² (1) = 6.97, p < 0.01) as compared to PGDM. Women with PGDM were at double the odds of postpartum psychopathology compared to those with GDM after controlling for several measured covariates (OR = 2.40, 95% CI 1.55–3.73). However, when HbA1c was included in the model, the elevated risk was eliminated (OR = 1.03, 95% CI 0.35–3.04). Conclusion As compared to GDM, PGDM was associated with increased odds of medical and social comorbidities. The relation between PGDM and postpartum psychopathology may be partially explained by elevated HbA1c.