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

## TL;DR

This study found that women with prediabetes after gestational diabetes often experience depressive symptoms, which are linked to worse metabolic health and lower quality of life, and a mobile-based lifestyle intervention did not improve mental health outcomes.

## Contribution

The study is the first to explore the link between depressive symptoms and metabolic outcomes in women with prediabetes after gestational diabetes and evaluate the impact of a mobile-based lifestyle intervention on mental health.

## Key findings

- Depressive symptoms were present in 26.5% of women at one year postpartum, with no significant difference between intervention and control groups.
- Women with depressive symptoms had worse metabolic profiles, higher anxiety, and lower quality of life at baseline and one year postpartum.
- The mobile-based lifestyle intervention did not significantly improve mental health outcomes in women with prediabetes after gestational diabetes.

## 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.