Objective: To determine whether there is an association between medical management with psychotherapy and/or SSRIs and improved pregnancy outcomes among pregnant women with coexisting diabetes and depression.
Methods: We performed a retrospective cohort study of women cared for at the Resident Diabetes in Pregnancy Clinic at a large, tertiary referral center from 2007-2017. Inclusion criteria included a diagnosis of T2DM or GDM by the 2-step method, using Carpenter-Coustan criteria, and depression, defined via chart review or baseline pregnancy Edinburgh Depression score >10. Patients with multiple gestations or fetal anomalies were excluded. Women who received medication therapy with SSRIs and/or psychotherapy were compared to those who did not. The primary outcome was large for gestational age birthweight (>90th %). Secondary outcomes included other maternal and fetal diabetes-related outcomes. Demographic characteristics were compared between groups and logistic regression was used to adjust for potential confounders, including advanced maternal age, Black race, BMI, and smoking.
Results: Of 926 women seen during the study period, 255 (28%) had depression and met study criteria—115 with T2DM and 118 with GDM. Of these, 69 (27 %) had no treatment, 149 received an SSRI (58%), 37 received therapy (15%), and 9 (4%) received both. Demographics were similar between groups. Women who received SSRIs had lower rates of LGA infants (17% vs. 25%, aOR 0.51; 95% CI 0.27-0.97), shoulder dystocia (1% vs. 8%, aOR 0.15; 95% CI 0.03-0.71), and umbilical artery cord gas <7.1 than those with no treatment. There were no differences in outcomes between women who received psychotherapy and those who did not. Findings were similar when the analysis was stratified by diabetes type.
Conclusions: Our findings suggest an association between improved diabetes-related pregnancy outcomes and SSRI use in women with diabetes. Further research is needed to determine potential mechanisms.
M.L. Scannell: None. H.E. Duckham: None. C.J. Herrick: None. E.B. Carter: None.
American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); Robert Wood Johnson Foundation (74250); Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD095075)