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

## TL;DR

Women with pre-existing diabetes are more likely to face medical and mental health challenges after childbirth compared to those with gestational diabetes.

## Contribution

This study identifies HbA1c as a potential mediator linking pre-existing diabetes to postpartum psychopathology.

## Key findings

- Women with pregestational diabetes had higher rates of cesarean delivery, NICU stays, and higher HbA1c levels compared to those with gestational diabetes.
- Low social connections were more common in women with gestational diabetes.
- Elevated HbA1c levels may explain the increased risk of postpartum psychopathology in women with pregestational diabetes.

## Abstract

We examine associations between pregestational Type 1 or Type 2 diabetes mellitus (PGDM) versus gestational diabetes mellitus (GDM) with postpartum psychopathology.

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.

Of 6,186 pregnancies, 111 (3%) experienced PGDM and 871 (23%) GDM. Patients with PGDM showed higher rates of cesarean delivery [X2 (1) = 9.30, p < 0.01], NICU stay [X2(1) = 21.65, p < 0.0001], and MICU stay [X2(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 (X2 (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).

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.