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

Associations between prenatal diabetes mellitus, social determinants of health, and postpartum psychopathology: A retrospective review within women with diabetes mellitus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations between prenatal diabetes mellitus, social determinants of health, and postpartum psychopathology: A retrospective review within women with diabetes mellitus Allie Sidwell, Quetzal A. Class This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7032300/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract 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. Gestational diabetes perinatal mental health postpartum depression type 1 diabetes mellitus type 2 diabetes mellitus Figures Figure 1 Introduction Diabetes mellitus (DM) is a prevalent metabolic disease that places added stress on many body systems, including the cardiovascular, renal, nervous, and gastrointestinal systems. 1 DM can manifest as Type 1 (T1DM), Type 2 (T2DM), or Gestational DM (GDM), distinctions that are driven by etiology and the timing of manifestation of symptoms. About 1-2% of pregnant people have T1DM or T2DM, and 6-9% of women develop GDM during pregnancy. 2 Developing GDM increases a patient’s chance of developing T2DM after pregnancy with a lifetime risk of up to 60%. 3 Furthermore, the percentage of pregnant people with GDM has more than doubled from 2000 to 2010, and during that same time period, the percentage of women with T1DM or T2DM increased by 37%, indicating that DM during pregnancy is a growing concern. 2 Previous research indicates that psychopathology, such as major depressive disorder, is more than three times higher in individuals with T1DM and twice as high in those with T2DM as compared with the general population. 4,5 Others have shown that quality of life is lower and depression/anxiety symptoms are high in nearly half of their studied GDM sample. 6 Less is known, however, about specific differential risk across T1DM, T2DM, and GDM and postpartum psychopathology. Besides duration of disease, one biological difference across DM type may be glycated hemoglobin (HbA1c) levels, a common diagnostic measure of DM. 7 Literature shows evidence of an association between HbA1c level and the development of depression. 8–10 Additionally, early HbA1c levels have been shown to differentially predict diagnosis of GDM, the likelihood of fetal anomaly, perinatal death, and maternal preeclampsia. 11 Perinatal mood disturbance is multifaceted with potentially long-term, far-reaching consequences for the mother and baby. 12 Thus, we aim to elucidate the association between DM, pregnancy, and peripartum mood disorders. Specifically, we compare rates of peripartum psychiatric diagnoses across women with differing forms of DM while controlling for other important factors, such as social determinants of health and comorbid medical diagnoses. Methods We conducted a retrospective cross-sectional study collecting data from electronic medical records of women who had a live birth at 22 gestational weeks or greater between March 1, 2020 and December 31, 2023. Initial data extraction from the University of Illinois Hospital in Chicago was performed by the Center for Clinical and Translational Sciences services following Institutional Review Board approval and waiver of informed consent (#2022 − 1045). We only included women diagnosed with GDM, T1DM or T2DM via ICD 9 and 10 codes (GDM: O24., T1DM: E10., T2DM: E11.). T1DM and T2DM were grouped into pre-existing DM (PGDM) categories. Each case was reviewed by hand (A.S.) for verification of diagnosis type and timing of prior to or within the current pregnancy. Demographic characteristics and medical comorbidities collected included preeclampsia, hypertension, anemia, and vitamin D deficiency. We also included if the patient was taking insulin or metformin during the prenatal period and her glycated hemoglobin (HbA1c) values assessed during pregnancy. For analyses, we focused on the maximum HbA1c value collected during the pregnancy. In addition, blood glucose levels from the glucose stress test during pregnancy were collected for women with GDM. We also recorded birth and delivery factors as well as social determinants of health. Social determinants of health included alcohol use, nicotine use, degree of stress, depression, experiencing interpersonal violence, physical activity, social connections, transportation, financial, food security, and housing instability. These factors are asked frequently, if not at every prenatal visit. If the indicator was ever endorsed by the patient within the study time frame, it was considered as endorsed for study. Maternal historic diagnosis of a mental health disorder within the 5 years prior to delivery was also collected. Primary outcomes included the scores of postpartum 2-week and 6-week Patient Health Questionnaire 9-question (PHQ9), as well as any perinatal diagnosis of depression, anxiety, and other psychopathologies within 1 year following delivery. 13 These diagnoses were broad and included ICD 9: 648.42, 293.89, 684.44, 300.00, 293.1, 300.02, 300.3, 309.28, 296.99, 296.80, 296.10, 296.13, 296.14, 300.4, 296.2, 799.29, 296.30 and ICD 10: O90.6, O99.345, F53, O99.34, F41.9, F05, F41.1, F42.9, F43.20, R45, F31, F30, F34.1, F32.9, R45.89, F33.9. Planned analyses Following descriptive analysis and univariate Chi-Square comparing PGDM and GDM across all measured factors, we used multivariable logistic regression to predict the categorical outcome of the presence of postpartum psychopathological diagnosis within a year of delivery. In a parallel fashion, we separately predicted PHQ9 depression screener scores from 2- and 6-week postpartum visits using Poisson regression to handle the count data of the depression screener. Two regression models were performed with the main predictor being type of DM with GDM as the reference category for PGDM. The first model adjusted for gestational age at birth, type of delivery (cesarean or vaginal), and neonatal intensive care unit (NICU) admission. The second model additionally adjusted for HbA1c max level during pregnancy. Although insulin use, hypertension, preeclampsia, SDoH low social connectedness, and psychiatric diagnosis within the 5 years prior to the first prenatal visit were associated with DM type, they were also associated with postpartum psychiatric diagnosis outcome and therefore we did not include these potential colliders in the models. In Fig. 1 we present a directed acyclic graph (DAG). This illustrates the potential relation of exposure of DM type (pregestational or gestational), the confounders of gestational age, cesarean section, NICU admission, and maximum HbA1c, and the outcome of postpartum psychiatric diagnosis as well as a list of the potential colliders (hypertension, preeclampsia, insulin, MICU, low social connectedness social determinant of health, and prior psychiatric diagnosis) that we did not include in the models. 13 Results Our sample began with 3,704 live births at 22 or more weeks gestation. When limiting the sample to women with a diagnosis of DM, 982 (26.5%) births remained. This included 871 with GDM diagnosed in the current pregnancy and 111 with PGDM made up of 54 T1DM and 57 T2DM diagnosed prior to the current pregnancy. As presented in Table 1 , univariate analyses showed that race, ethnicity, and insurance status did not differ across those with GDM versus those with PGDM. Those with PGDM, as compared to those diagnosed with GDM, were found to have higher rates of cesarean section deliveries [X 2 (1, N) = 9.30, p < 0.01], NICU stays when limited to full-term births only [X 2 (1, N) = 21.6524, p < 0.0001], MICU stays [X 2 (1, N) = 7.051, p < 0.008], preeclampsia [X 2 (1, N) = 3.9235, p < 0.0476], and hypertension [X 2 (1, N) = 9.5190, p < 0.0020]. Gestational age at birth was shown to be significantly lower for women with PGDM (36.40+- 3.70 weeks) than women with GDM [37.75 +-2.38 weeks; t(978) = 5.20, p < 0.001]. A higher than expected number of people with GDM endorsed SDoH factor social isolation as compared to those with PGDM, [X 2 (1, N) = 6.97, p < 0.01]. For the SDoH factors of alcohol use, housing instability, intimate partner violence, and transportation difficulties, there were not enough cases of endorsement for these factors to be analysed. No differences across DM diagnosis type were noted across any other social determinants of health factors (Table 1 ). Table 1 Demographic and background factors across diabetes mellitus diagnosis groups of pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) Factors GDM, n (% or sd) PGDM, n (% or sd) t or X 2 , df, p n 111 879 — BMI (kg/m 2 ) 35.34, 863 (8.71) 37.07, 109 (9.80) -1.92, 970, 0.055 Maternal age at delivery (yrs) 31.42, 871 (5.87) 32.54, 111 (5.74) -1.89, 980, 0.059 Gestational age (weeks) 37.75, 869 (2.38) 36.40, 111 (3.70) 5.20, 978, < 0.001 Neonatal birth weight (g) 3121.52, 856 (677.98) 2983.25, 109 (880.06) 1.93, 963, 0.054 Postpartum 2-week PHQ9 2.10, 150 (3.311) 3.00, 5 (4.80) -0.59, 153, 0.556 Postpartum 6-week PHQ9 2.59, 9 (3.754) 4.78, 9 (5.63) -1.66, 182, 0.098 Race 11.06, 5, 0.0503 White 105 (12.06) 18 (16.22) Black 372 (42.71) 52 (46.85) Other 394 (45.23) 41 (36.93) Ethnicity 2.84, 3, 0.4164 Non-Hispanic 489 (56.14) 61 (54.95) Hispanic 318 (36.51) 39 (35.14) Declined or Unknown 64 (7.35) 11 (9.91) Insurance 0.07, 1, 0.7907 Private 222 (25.49) 27 (24.32) Public 649 (74.51) 84 (75.68) Cesarean Section 9.30, 1, 0.0023 No 493 (56.73) 46 (41.44) Yes 376 (43.27) 65 (58.56) NICU stay, full-term only 21.65, 1, < 0.0001 No 455 (56.73) 33 (32.35) Yes 347 (43.27) 69 (67.65) Maternal ICU Admission 7.05, 1, 0.008 No 684 (88.37) 74 (78.72) Yes 90 (11.63) 20 (21.27) Preeclampsia 3.92, 1, 0.0476 No 613 (70.46) 68 (61.26) Yes 257 (29.54) 43 (38.74) Hypertension 9.52, 1, 0.0020 No 433 (49.77) 38 (34.23) Yes 437 (50.23) 73 (65.77) Postpartum or Pregnancy-related Psychiatric Diagnosis within 1 year after delivery 21.94, 1, < 0.0001 No 684 (78.62) 65 (58.56) Yes 186 (21.38) 46 (41.44) SDoH Factors Depression 1.40, 1, 0.2471 No 811 (93.11) 100 (90.09) Yes 60 (6.89) 11 (9.91) Financial Struggles 1.54, 1, 0.2146 No 855 (98.16) 107 (96.40) Yes 16 (1.84) 4 (3.60) Food Instability 2.83, 1, 0.0925 No 863 (99.08) 108 (97.30) Yes 8 (0.92) 3 (2.70) Insufficient Physical Activity 2.69, 1, 0.1008 No 733 (84.16) 100 (90.09) Yes 138 (15.84) 11 (9.91) Social Isolation 6.97, 1, 0.0083 No 864 (99.20) 107 (96.40) Yes 7 (0.80) 4 (3.60) Stress 0.13, 1, 0.7214 No 845 (97.01) 107 (96.40) Yes 26 (2.99) 4 (3.60) Tobacco Use 1.63, 1, 0.2027 No 746 (85.65) 90 (81.08) Yes 125 (14.35) 21 (18.92) Alcohol – No 852 (97.82) 110 (99.10) Yes 19 (2.18) 1 (0.90) Housing Instability – No 869 (99.77) 111 (100.00) Yes 2 (0.23) 0 (0.00) Intimate Partner Violence – No 871 (100.00) 111 (100.00) Yes 0 (0.00) 0 (0.00) Transportation Issues – No 868 (99.66) 111 (100.00) Yes 3 (0.34) 0 (0.00) Insulin 85.47, 1, 0.001 No 589 (67.62) 25 (22.52) Yes 282 (32.38) 86 (77.48) Metformin 6.98, 1, 0.0082 No 547 (65.90) 59 (53.15) Yes 297 (34.10) 52 (46.85) HbA1c 6.5 or greater 9.15, 1, 0.0025 No 202 (72.40) 12 (44.44) Yes 77 (27.60) 15 (55.56) NOTE: SDoH: Social determinants of health ever endorsed within the study window Also presented in Table 1 , DM-related medications and HbA1c showed differential rates between DM groups. In particular, we found that women were prescribed insulin [X 2 (1, N) = 85.47, p < 0.01] and metformin [X 2 (1, N) = 6.98, p < 0.01] more often if they had PGDM as compared to GDM. The maximum HbA1c levels measured at any point in pregnancy were also significantly higher in women with PGDM [7.14 (+/- 1.67) mmol/mol, range: 4.80–12.70 mmol/mol] as compared to GDM [6.18 (+/- 1.49) mmol/mol; range: 4.50–14.40 mmol/mol]. This was true when HbA1c was measured as a continuous values, [t(304) = 9.92, p = 0.0018 (p < 0.01)], and also when examined categorically with an above or below 6.5 mmol/mol binary indicator [X 2 (1) = 9.15, p < 0.0025]. HbA1c was not associated with postpartum psychiatric diagnosis [t(303) = 1.06, p = 0.29]. Women with PGDM showed higher rates of history of psychiatric diagnoses within the 5 years prior to their index pregnancy [X 2 (1, N) = 24.97, p < 0.0001] as compared to women with GDM. As compared to women with GDM, univariate analyses showed that women with PGDM also had higher rates of postpartum or pregnancy-related psychiatric diagnosis within a year post-delivery, [X 2 (1, N) = 21.94, p < 0.0001], one of our primary outcome variables. However, no significant differences in PHQ9 screening scores at 2- or 6-weeks postpartum were noted across diagnosis groups and therefore these outcomes were not studied using multivariable regression. We then performed multivariable logistic regression predicting diagnosis of a psychiatric condition that adjusted for factors found to be significantly different across the DM groups plus core demographic characteristics. Results for the multivariable logistic regressions are presented in Table 2 . In Model 1, which adjusted for gestational age, type of delivery, NICU, women with PGDM were at 2.40 higher odds (95% CI 1.55–3.73) of developing a postpartum psychiatric diagnosis within the first year postpartum as compared to women with GDM. In Model 2 we additionally adjusted for HbA1c in a subsample with HbA1c levels measured during pregnancy. With this additional adjustment, the elevated odds for postpartum psychiatric diagnosis for women with PGDM as compared with GDM was eliminated, [OR = 1.03 (95% CI 0.35–3.04)]. Table 2 Multivariable logistic regression models predicting pregnancy and postpartum psychiatric diagnosis in the year following delivery Factors Model 1, OR (95% CI), n = 901 Model 2, OR (95% CI), n = 272 subsample PGDM (GDM reference) 2.40 (1.55–3.73) 1.03 (0.35–3.04) Gestational age, weeks 0.95 (0.90–1.01) 1.00 (0.89–1.12) Cesarean Section 1.00 (0.72–1.39) 0.89 (0.49–1.59) NICU 1.12 (0.79–1.59) 1.19 (0.62–2.28) HbA1c 0.92 (0.75–1.12) Discussion In our urban sample of mostly Black and publicly-insured patients, we found that a diagnosis of PGDM, meaning either T1DM or T2DM prior to the pregnancy, was associated with double the odds of pregnancy and postpartum-related psychiatric diagnoses in the first year postpartum when compared to women who received a new GDM diagnosis. This association was independent of several important measured covariates. Our findings support previous research showing postpartum PHQ9 scores were higher for patients with PGDM as compared to GDM. 15 The seemingly time-limited nature of GDM may lessen the psychological impact of the new diagnosis as compared with the chronic nature of a PGDM diagnosis. Given that GDM often leads to a T2DM diagnosis, however, early screening and management of GDM is warranted, emphasizing the importance of integrated, longitudinal care. 3 There are few other studies directly comparing GDM and PGDM, but rather comparing patients with one form of DM with patients without DM. For example, one study found that pregnant people with T1DM had significantly lower Standardized Mental Component scores than pregnant individuals without T1DM. 16 While a prospective cohort study of 800 patients found that the Edinburgh Postnatal Depression Scale and Perceived Stress Scale did not differ between pregnant people with and without T1DM, though again this was not comparing within women with metabolic disorders. 17 Additionally, postpartum mood is studied using numerous methods of measurement or other psychiatric illness and thus, associations vary naturally. When examining risk for psychological outcomes and T2DM, a case-control study found that T2DM during pregnancy was not a significant risk factor for psychopathology during pregnancy, 18 but a prospective cohort study of 178 patients found that women with T2DM during pregnancy were significantly more likely to have symptoms of anxiety and/or depression. 5 Meta analyses have shown both statistically significant relations between GDM and postpartum depression as well as no statistically significant relationship. 19 , 20 , 21 Interestingly and importantly, however, in a smaller subcohort of our sample we found that when HbA1c was included in the predictive model, the association between diabetes type and postpartum psychological outcome was no longer significant. Our finding may help explain the high levels of variability in outcomes across this area of study. Our findings may also be interpreted as underscoring the important relation between blood glucose and mental health — an association that may transcend diagnostic categories. Previous work has presented biological mechanisms that support an association between blood glucose and metabolic function and mental health. 8 – 10 Additionally, the walkability of one's community has been shown to lead to better glycemic control in women with pregestational diabetes, a factor that may be associated with several aspects of what are considered social determinants of health. 22 Examining social determinants of health factors showed that women with GDM were at higher risk of endorsing social isolation as compared with women with PGDM. People with low social connection are more likely to delay seeking medical care. 23 Additionally, social isolation and loneliness are linked to increased mortality 24 and studies using social capital and neighborhood deprivation as markers for low social connection saw significantly increased rates of GDM. 25 , 26 However, increased rates of T2DM are also associated with social isolation and loneliness. 27 , 28 We encourage future research on this important factor. While our study moves the field forward by comparing metabolically similar patients and including a breadth of measured covariates, there are important limitations to consider. First, many PHQ9 scores were not recorded within the patient electronic medical record. We are unsure if this was due to zero scores and therefore the provider did not enter a score or if the standard screener was not given to the patient. Second, at our hospital, the Edinburgh Postnatal Depression Scale may be used as an alternative to the PHQ9. 13 There were a total of 34 2-week and 17 6-week Edinburgh Postnatal Depression Scores in our sample though none of these scores were recorded for women without PHQ9 scores. Therefore, we did not utilize the Edinburgh Postnatal Depression Scale information. Third, it may have been the case that while delivery occurred at our hospital, the patient received psychological care elsewhere and their diagnosis is not reflected in our data. In addition, previous work has suggested associations between antipsychotic medication and risk for GDM. 19 While the confounding here may be limited due to the decreased likelihood of taking an antipsychotic prescription during pregnancy, future research should consider investigating the role of including psychiatric medications. Finally, though DM type and diagnosis was reviewed by hand, there are still inherent human errors in electronic medical records that are translated into study data. Early and continuous screening for pregnancy and postpartum mental health disorders are warranted to prevent adverse events in the mother and child. Targeted interventions may be beneficial in certain populations including those with PGDM. Psychological interventions that specifically address the needs of pregnant and postpartum women with DM, perhaps that additionally target behavioral health changes in nutrition and glycemic control, may be beneficial for the management of both DM and mental health issues. Conclusions In conclusion, individuals with PGDM were at higher risk for postpartum psychiatric diagnosis, as well as several adverse birth outcomes and comorbidities, as compared to GDM. The relation between diabetes type and postpartum psychiatric diagnosis was fully attenuated with the inclusion of HbA1c. Our study shows important differences between DM type experienced during pregnancy which may be important to consider in patient care. More research into the biological link between DM and mental health is warranted as HbA1c levels are manageable. Abbreviations DM diabetes mellitus GDM gestational diabetes mellitus HbA1c glycated hemoglobin NICU neonatal intensive care unit PGDM pregestational diabetes mellitus PHQ9 Patient Health Questionnaire 9-question T1DM type 1 diabetes mellitus T2DM type 2 diabetes mellitus Declarations Ethics approval and consent to participate: This study was approved by the University of Illinois, Chicago Institutional Review Board (#2022 − 1045) and was determined to be “exempt” with a waiver for participant consent in accordance with the Declaration of Helsinki. Consent for publication: A waiver of consent was granted from the University of Illinois, Institutional Review Board (#2022 − 1045). Funding The project described was supported by the National Center for Advancing Translational Sciences (NCATS) National Institutes of Health, through Grant Award UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We have no other sources of financial support to report. Author Contribution Q.C. designed the study. A.S. hand-reviewed and cleaned the data. A.S. performed a literature review. Q.C. performed the statistical analysis. Q.C. and A.S. interpreted the results. Q.C. and A.S. wrote the manuscript and approved the final version. Acknowledgements We acknowledge the patients and providers at the University of Illinois Health. Data Availability The data are available from the corresponding author upon reasonable request. References National Diabetes Statistics Report | Diabetes | CDC, June. 29, 2022. Accessed March 5, 2023. https://www.cdc.gov/diabetes/data/statistics-report/index.html Diabetes During Pregnancy | Maternal Infant Health | Reproductive Health | CDC, January. 16, 2019. Accessed March 5, 2023. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-during-pregnancy.htm Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes. 2015;6(2):234–44. 10.4239/wjd.v6.i2.234 . Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142:S8–21. 10.1016/S0165-0327(12)70004-6 . Suppl. Ásbjörnsdóttir B, Vestgaard M, Do NC, et al. Prevalence of anxiety and depression symptoms in pregnant women with type 2 diabetes and the impact on glycaemic control. Diabet Med. 2021;38(3):e14506. 10.1111/dme.14506 . Nazarpour S, Simbar M, Kiani Z, Khalaji N, Khorrami Khargh M, Naeiji Z. The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study. BMC Psychiatry. 2024;24(1):511. 10.1186/s12888-024-05960-4 . Byford AR, Forbes K, Scott EM. Glucose Treatment Targets in Pregnancy - A Review of Evidence and Guidelines. Curr Diabetes Rev. 2023;19(2):e220422203917. 10.2174/1573399818666220422083935 . Kan C, Silva N, Golden SH, et al. A Systematic Review and Meta-analysis of the Association Between Depression and Insulin Resistance. Diabetes Care. 2013;36(2):480–9. 10.2337/dc12-1442 . Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does Glycemic Variability Impact Mood and Quality of Life? Diabetes Technol Ther. 2012;14(4):303–10. 10.1089/dia.2011.0191 . Geraets AFJ, Köhler S, Muzambi R, et al. The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study. Diabetologia. 2020;63(11):2315–28. 10.1007/s00125-020-05247-9 . Hughes RCE, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c ≥ 5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care. 2014;37(11):2953–9. 10.2337/dc14-1312 . Garapati J, Jajoo S, Aradhya D, Reddy LS, Dahiphale SM, Patel DJ. Postpartum Mood Disorders: Insights into Diagnosis, Prevention, and Treatment. Cureus 15(7):e42107. 10.7759/cureus.42107 Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J GEN INTERN MED. 2001;16:606–13. 10.1046/j.1525-1497.2001.016009606.x . Feeney T, Hartwig FP, Davies NM. How to use directed acyclic graphs: guide for clinical researchers. BMJ. 2025;388:e078226. 10.1136/bmj-2023-078226 . Miller ES, Peri MR, Gossett DR. The association between diabetes and postpartum depression. Arch Womens Ment Health. 2016;19(1):183–6. 10.1007/s00737-015-0544-x . Dalfrà MG, Nicolucci A, Bisson T, Bonsembiante B, Lapolla A, QLISG (Quality of Life Italian Study Group). Quality of life in pregnancy and post-partum: a study in diabetic patients. Qual Life Res. 2012;21(2):291–8. 10.1007/s11136-011-9940-5 . Hall M, Oakey H, Penno MAS, et al. Mental Health During Late Pregnancy and Postpartum in Mothers With and Without Type 1 Diabetes: The ENDIA Study. Diabetes Care. 2022;45(5):1082–90. 10.2337/dc21-2335 . Hasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T. Pregnancy complications, mental health-related problems and type 2 diabetes mellitus in Malaysian women. Diabetes Metab Syndr. 2013;7(4):191–7. 10.1016/j.dsx.2013.10.023 . Riggin L. Association Between Gestational Diabetes and Mental Illness. Can J Diabetes. 2020;44(6):566–e5713. 10.1016/j.jcjd.2020.06.014 . Liu X, Wang S, Wang G. Prevalence and Risk Factors of Postpartum Depression in Women: A Systematic Review and Meta-analysis. J Clin Nurs. 2022;31(19–20):2665–77. 10.1111/jocn.16121 . Arafa A, Dong JY. Gestational diabetes and risk of postpartum depressive symptoms: A meta-analysis of cohort studies. J Affect Disord. 2019;253:312–6. 10.1016/j.jad.2019.05.001 . Field C, Lynch CD, Fareed N, et al. Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus. Am J Obstet Gynecol MFM. 2023;5(5). 10.1016/j.ajogmf.2023.100898 . Reisinger MW, Moss M, Clark BJ. Is lack of social support associated with a delay in seeking medical care? A cross-sectional study of Minnesota and Tennessee residents using data from the Behavioral Risk Factor Surveillance System. BMJ Open. 2018;8(7):e018139. 10.1136/bmjopen-2017-018139 . Yu B. Social disconnection and mortality: new evidence for old truths. Trends Cogn Sci. 2023;27(10):890–1. 10.1016/j.tics.2023.08.001 . Mizuno S, Nishigori H, Sugiyama T, et al. Association between social capital and the prevalence of gestational diabetes mellitus: An interim report of the Japan Environment and Children’s Study. Diabetes Res Clin Pract. 2016;120:132–41. 10.1016/j.diabres.2016.07.020 . Liu EF, Ferrara A, Sridhar SB, Greenberg MB, Hedderson MM. Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus. Obstet Gynecol. 2024;144(5):670–6. 10.1097/AOG.0000000000005521 . Loneliness increases the risk of type 2 diabetes: a 20 year follow-up - results from the HUNT study - PubMed. Accessed March 20. 2025. https://pubmed.ncbi.nlm.nih.gov/36168066/ Hackett RA, Hudson JL, Chilcot J. Loneliness and type 2 diabetes incidence: findings from the English Longitudinal Study of Ageing. Diabetologia. 2020;63(11):2329–38. 10.1007/s00125-020-05258-6 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 31 Jul, 2025 Editor assigned by journal 31 Jul, 2025 Editor invited by journal 16 Jul, 2025 Submission checks completed at journal 15 Jul, 2025 First submitted to journal 15 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7032300","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493948396,"identity":"5e0369c6-2712-4702-8efb-a08039b7f039","order_by":0,"name":"Allie Sidwell","email":"","orcid":"","institution":"University of Illinois College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Allie","middleName":"","lastName":"Sidwell","suffix":""},{"id":493948399,"identity":"d4e16c2d-be13-4e04-a030-8d0afc5b548c","order_by":1,"name":"Quetzal A. Class","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYHACxgNAQo6BGcRmI1IPSIsx6VoSGxiI1cJ3/PCDAz/+1KVvOM78gOFD2WHCWiTPpBkc7G07nLvhMJsB44xzRGgxOJDDcIC34QBQCw8DM28bMVrOv2E4+AfoMAOQlr9EabmRw3CYh405AayFkRgtkjeeGRyWbTtsOBPol4M959IJa+E7n/zw4Zs/dfJ85w8/fPCjzJqwFnCkYGMTqWUUjIJRMApGAVYAAMqZQC9R8jTYAAAAAElFTkSuQmCC","orcid":"","institution":"University of Illinois at Chicago","correspondingAuthor":true,"prefix":"","firstName":"Quetzal","middleName":"A.","lastName":"Class","suffix":""}],"badges":[],"createdAt":"2025-07-02 19:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7032300/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7032300/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88422614,"identity":"9fffeae9-87a8-458e-bedd-f7e6fea1268e","added_by":"auto","created_at":"2025-08-06 09:37:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37802,"visible":true,"origin":"","legend":"\u003cp\u003eDirected acyclic graph outlining regression model\u003c/p\u003e\n\u003cp\u003eDirected acyclic graph aided in the determination of variables included in the logistic regression model predicting postpartum psychopathology from diabetes type experienced during pregnancy. Colliders were removed from the model due to associations with the exposure and the outcome. Confounders were only associated with the exposure.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7032300/v1/da1a3a1fdc9e17884ffa1d7a.png"},{"id":88424128,"identity":"3cd7b70f-a21d-4c55-9083-472121568158","added_by":"auto","created_at":"2025-08-06 09:45:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":808416,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7032300/v1/ef7b5e46-3f1b-4a23-a18b-e0ae19ead58e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations between prenatal diabetes mellitus, social determinants of health, and postpartum psychopathology: A retrospective review within women with diabetes mellitus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus (DM) is a prevalent metabolic disease that places added stress on many body systems, including the cardiovascular, renal, nervous, and gastrointestinal systems.\u003csup\u003e1\u003c/sup\u003e DM can manifest as Type 1 (T1DM), Type 2 (T2DM), or Gestational DM (GDM), distinctions that are driven by etiology and the timing of manifestation of symptoms. About 1-2% of pregnant people have T1DM or T2DM, and 6-9% of women develop GDM during pregnancy.\u003csup\u003e2\u003c/sup\u003e Developing GDM increases a patient\u0026rsquo;s chance of developing T2DM after pregnancy with a lifetime risk of up to 60%.\u003csup\u003e3\u003c/sup\u003e Furthermore, the percentage of pregnant people with GDM has more than doubled from 2000 to 2010, and during that same time period, the percentage of women with T1DM or T2DM increased by 37%, indicating that DM during pregnancy is a growing concern.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePrevious research indicates that psychopathology, such as major depressive disorder, is more than three times higher in individuals with T1DM and twice as high in those with T2DM as compared with the general population.\u003csup\u003e4,5\u003c/sup\u003e Others have shown that quality of life is lower and depression/anxiety symptoms are high in nearly half of their studied GDM sample.\u003csup\u003e6\u003c/sup\u003e Less is known, however, about specific differential risk across T1DM, T2DM, and GDM and postpartum psychopathology. Besides duration of disease, one biological difference across DM type may be glycated hemoglobin (HbA1c) levels, a common diagnostic measure of DM.\u003csup\u003e7\u003c/sup\u003e Literature shows evidence of an association between HbA1c level and the development of depression.\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e Additionally, early HbA1c levels have been shown to differentially predict diagnosis of GDM, the likelihood of fetal anomaly, perinatal death, and maternal preeclampsia.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePerinatal mood disturbance is multifaceted with potentially long-term, far-reaching consequences for the mother and baby.\u003csup\u003e12\u003c/sup\u003e Thus, we aim to elucidate the association between DM, pregnancy, and peripartum mood disorders. Specifically, we compare rates of peripartum psychiatric diagnoses across women with differing forms of DM while controlling for other important factors, such as social determinants of health and comorbid medical diagnoses.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted a retrospective cross-sectional study collecting data from electronic medical records of women who had a live birth at 22 gestational weeks or greater between March 1, 2020 and December 31, 2023. Initial data extraction from the University of Illinois Hospital in Chicago was performed by the Center for Clinical and Translational Sciences services following Institutional Review Board approval and waiver of informed consent (#2022\u0026thinsp;\u0026minus;\u0026thinsp;1045). We only included women diagnosed with GDM, T1DM or T2DM via ICD 9 and 10 codes (GDM: O24., T1DM: E10., T2DM: E11.). T1DM and T2DM were grouped into pre-existing DM (PGDM) categories. Each case was reviewed by hand (A.S.) for verification of diagnosis type and timing of prior to or within the current pregnancy.\u003c/p\u003e\u003cp\u003eDemographic characteristics and medical comorbidities collected included preeclampsia, hypertension, anemia, and vitamin D deficiency. We also included if the patient was taking insulin or metformin during the prenatal period and her glycated hemoglobin (HbA1c) values assessed during pregnancy. For analyses, we focused on the maximum HbA1c value collected during the pregnancy. In addition, blood glucose levels from the glucose stress test during pregnancy were collected for women with GDM. We also recorded birth and delivery factors as well as social determinants of health. Social determinants of health included alcohol use, nicotine use, degree of stress, depression, experiencing interpersonal violence, physical activity, social connections, transportation, financial, food security, and housing instability. These factors are asked frequently, if not at every prenatal visit. If the indicator was ever endorsed by the patient within the study time frame, it was considered as endorsed for study. Maternal historic diagnosis of a mental health disorder within the 5 years prior to delivery was also collected.\u003c/p\u003e\u003cp\u003ePrimary outcomes included the scores of postpartum 2-week and 6-week Patient Health Questionnaire 9-question (PHQ9), as well as any perinatal diagnosis of depression, anxiety, and other psychopathologies within 1 year following delivery.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e These diagnoses were broad and included ICD 9: 648.42, 293.89, 684.44, 300.00, 293.1, 300.02, 300.3, 309.28, 296.99, 296.80, 296.10, 296.13, 296.14, 300.4, 296.2, 799.29, 296.30 and ICD 10: O90.6, O99.345, F53, O99.34, F41.9, F05, F41.1, F42.9, F43.20, R45, F31, F30, F34.1, F32.9, R45.89, F33.9.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePlanned analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing descriptive analysis and univariate Chi-Square comparing PGDM and GDM across all measured factors, we used multivariable logistic regression to predict the categorical outcome of the presence of postpartum psychopathological diagnosis within a year of delivery. In a parallel fashion, we separately predicted PHQ9 depression screener scores from 2- and 6-week postpartum visits using Poisson regression to handle the count data of the depression screener.\u003c/p\u003e\u003cp\u003eTwo regression models were performed with the main predictor being type of DM with GDM as the reference category for PGDM. The first model adjusted for gestational age at birth, type of delivery (cesarean or vaginal), and neonatal intensive care unit (NICU) admission. The second model additionally adjusted for HbA1c max level during pregnancy. Although insulin use, hypertension, preeclampsia, SDoH low social connectedness, and psychiatric diagnosis within the 5 years prior to the first prenatal visit were associated with DM type, they were also associated with postpartum psychiatric diagnosis outcome and therefore we did not include these potential colliders in the models.\u003c/p\u003e\u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e we present a directed acyclic graph (DAG). This illustrates the potential relation of exposure of DM type (pregestational or gestational), the confounders of gestational age, cesarean section, NICU admission, and maximum HbA1c, and the outcome of postpartum psychiatric diagnosis as well as a list of the potential colliders (hypertension, preeclampsia, insulin, MICU, low social connectedness social determinant of health, and prior psychiatric diagnosis) that we did not include in the models.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur sample began with 3,704 live births at 22 or more weeks gestation. When limiting the sample to women with a diagnosis of DM, 982 (26.5%) births remained. This included 871 with GDM diagnosed in the current pregnancy and 111 with PGDM made up of 54 T1DM and 57 T2DM diagnosed prior to the current pregnancy.\u003c/p\u003e\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, univariate analyses showed that race, ethnicity, and insurance status did not differ across those with GDM versus those with PGDM. Those with PGDM, as compared to those diagnosed with GDM, were found to have higher rates of cesarean section deliveries [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;9.30, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01], NICU stays when limited to full-term births only [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;21.6524, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001], MICU stays [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;7.051, p\u0026thinsp;\u0026lt;\u0026thinsp;0.008], preeclampsia [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;3.9235, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0476], and hypertension [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;9.5190, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0020]. Gestational age at birth was shown to be significantly lower for women with PGDM (36.40+- 3.70 weeks) than women with GDM [37.75 +-2.38 weeks; t(978)\u0026thinsp;=\u0026thinsp;5.20, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001]. A higher than expected number of people with GDM endorsed SDoH factor social isolation as compared to those with PGDM, [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;6.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01]. For the SDoH factors of alcohol use, housing instability, intimate partner violence, and transportation difficulties, there were not enough cases of endorsement for these factors to be analysed. No differences across DM diagnosis type were noted across any other social determinants of health factors (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and background factors across diabetes mellitus diagnosis groups of pregestational diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGDM, n (% or sd)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePGDM, n (% or sd)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et or X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, df, p\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e879\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.34, 863 (8.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.07, 109 (9.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.92, 970, 0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal age at delivery (yrs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.42, 871 (5.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.54, 111 (5.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.89, 980, 0.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.75, 869 (2.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.40, 111 (3.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5.20, 978, \u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal birth weight (g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3121.52, 856 (677.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2983.25, 109 (880.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.93, 963, 0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum 2-week PHQ9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.10, 150 (3.311)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00, 5 (4.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.59, 153, 0.556\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum 6-week PHQ9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.59, 9 (3.754)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.78, 9 (5.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.66, 182, 0.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.06, 5, 0.0503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105 (12.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (16.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e372 (42.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (46.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e394 (45.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (36.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.84, 3, 0.4164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e489 (56.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (54.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318 (36.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (35.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeclined or Unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (7.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (9.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsurance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07, 1, 0.7907\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e222 (25.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (24.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e649 (74.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84 (75.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean Section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9.30, 1, 0.0023\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e493 (56.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (41.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e376 (43.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (58.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU stay, full-term only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e21.65, 1, \u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e455 (56.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (32.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e347 (43.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (67.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal ICU Admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e7.05, 1, 0.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e684 (88.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74 (78.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (11.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (21.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3.92, 1, 0.0476\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e613 (70.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (61.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e257 (29.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (38.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9.52, 1, 0.0020\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e433 (49.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (34.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e437 (50.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73 (65.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum or Pregnancy-related Psychiatric Diagnosis within 1 year after delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e21.94, 1, \u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e684 (78.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (58.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e186 (21.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (41.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSDoH Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.40, 1, 0.2471\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e811 (93.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (90.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (6.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (9.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancial Struggles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.54, 1, 0.2146\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e855 (98.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (96.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16 (1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFood Instability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.83, 1, 0.0925\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e863 (99.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (97.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsufficient Physical\u003c/p\u003e\u003cp\u003eActivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.69, 1, 0.1008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e733 (84.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100 (90.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138 (15.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (9.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e6.97, 1, 0.0083\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e864 (99.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (96.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.13, 1, 0.7214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e845 (97.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (96.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (2.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTobacco Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.63, 1, 0.2027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e746 (85.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (81.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125 (14.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (18.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e852 (97.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110 (99.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (2.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousing Instability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e869 (99.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntimate Partner Violence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e871 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTransportation Issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e868 (99.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsulin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e85.47, 1, 0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e589 (67.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (22.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e282 (32.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (77.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e6.98, 1, 0.0082\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e547 (65.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (53.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e297 (34.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (46.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c 6.5 or greater\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e9.15, 1, 0.0025\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202 (72.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (44.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (27.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNOTE: SDoH: Social determinants of health ever endorsed within the study window\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlso presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, DM-related medications and HbA1c showed differential rates between DM groups. In particular, we found that women were prescribed insulin [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;85.47, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01] and metformin [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;6.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01] more often if they had PGDM as compared to GDM. The maximum HbA1c levels measured at any point in pregnancy were also significantly higher in women with PGDM [7.14 (+/- 1.67) mmol/mol, range: 4.80\u0026ndash;12.70 mmol/mol] as compared to GDM [6.18 (+/- 1.49) mmol/mol; range: 4.50\u0026ndash;14.40 mmol/mol]. This was true when HbA1c was measured as a continuous values, [t(304)\u0026thinsp;=\u0026thinsp;9.92, p\u0026thinsp;=\u0026thinsp;0.0018 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)], and also when examined categorically with an above or below 6.5 mmol/mol binary indicator [X\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;9.15, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0025]. HbA1c was not associated with postpartum psychiatric diagnosis [t(303)\u0026thinsp;=\u0026thinsp;1.06, p\u0026thinsp;=\u0026thinsp;0.29].\u003c/p\u003e\u003cp\u003eWomen with PGDM showed higher rates of history of psychiatric diagnoses within the 5 years prior to their index pregnancy [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;24.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001] as compared to women with GDM. As compared to women with GDM, univariate analyses showed that women with PGDM also had higher rates of postpartum or pregnancy-related psychiatric diagnosis within a year post-delivery, [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1, N)\u0026thinsp;=\u0026thinsp;21.94, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001], one of our primary outcome variables. However, no significant differences in PHQ9 screening scores at 2- or 6-weeks postpartum were noted across diagnosis groups and therefore these outcomes were not studied using multivariable regression.\u003c/p\u003e\u003cp\u003eWe then performed multivariable logistic regression predicting diagnosis of a psychiatric condition that adjusted for factors found to be significantly different across the DM groups plus core demographic characteristics. Results for the multivariable logistic regressions are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In Model 1, which adjusted for gestational age, type of delivery, NICU, women with PGDM were at 2.40 higher odds (95% CI 1.55\u0026ndash;3.73) of developing a postpartum psychiatric diagnosis within the first year postpartum as compared to women with GDM. In Model 2 we additionally adjusted for HbA1c in a subsample with HbA1c levels measured during pregnancy. With this additional adjustment, the elevated odds for postpartum psychiatric diagnosis for women with PGDM as compared with GDM was eliminated, [OR\u0026thinsp;=\u0026thinsp;1.03 (95% CI 0.35\u0026ndash;3.04)].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable logistic regression models predicting pregnancy and postpartum psychiatric diagnosis in the year following delivery\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModel 1, OR (95% CI), n\u0026thinsp;=\u0026thinsp;901\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModel 2, OR (95% CI), n\u0026thinsp;=\u0026thinsp;272 subsample\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePGDM (GDM reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.40 (1.55\u0026ndash;3.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.03 (0.35\u0026ndash;3.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age, weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.95 (0.90\u0026ndash;1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.00 (0.89\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean Section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.00 (0.72\u0026ndash;1.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.89 (0.49\u0026ndash;1.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.12 (0.79\u0026ndash;1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.19 (0.62\u0026ndash;2.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHbA1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.92 (0.75\u0026ndash;1.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our urban sample of mostly Black and publicly-insured patients, we found that a diagnosis of PGDM, meaning either T1DM or T2DM prior to the pregnancy, was associated with double the odds of pregnancy and postpartum-related psychiatric diagnoses in the first year postpartum when compared to women who received a new GDM diagnosis. This association was independent of several important measured covariates. Our findings support previous research showing postpartum PHQ9 scores were higher for patients with PGDM as compared to GDM.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The seemingly time-limited nature of GDM may lessen the psychological impact of the new diagnosis as compared with the chronic nature of a PGDM diagnosis. Given that GDM often leads to a T2DM diagnosis, however, early screening and management of GDM is warranted, emphasizing the importance of integrated, longitudinal care.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThere are few other studies directly comparing GDM and PGDM, but rather comparing patients with one form of DM with patients without DM. For example, one study found that pregnant people with T1DM had significantly lower Standardized Mental Component scores than pregnant individuals without T1DM.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e While a prospective cohort study of 800 patients found that the Edinburgh Postnatal Depression Scale and Perceived Stress Scale did not differ between pregnant people with and without T1DM, though again this was not comparing within women with metabolic disorders.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Additionally, postpartum mood is studied using numerous methods of measurement or other psychiatric illness and thus, associations vary naturally. When examining risk for psychological outcomes and T2DM, a case-control study found that T2DM during pregnancy was not a significant risk factor for psychopathology during pregnancy,\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e but a prospective cohort study of 178 patients found that women with T2DM during pregnancy were significantly more likely to have symptoms of anxiety and/or depression.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Meta analyses have shown both statistically significant relations between GDM and postpartum depression as well as no statistically significant relationship.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eInterestingly and importantly, however, in a smaller subcohort of our sample we found that when HbA1c was included in the predictive model, the association between diabetes type and postpartum psychological outcome was no longer significant. Our finding may help explain the high levels of variability in outcomes across this area of study. Our findings may also be interpreted as underscoring the important relation between blood glucose and mental health \u0026mdash; an association that may transcend diagnostic categories. Previous work has presented biological mechanisms that support an association between blood glucose and metabolic function and mental health.\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Additionally, the walkability of one's community has been shown to lead to better glycemic control in women with pregestational diabetes, a factor that may be associated with several aspects of what are considered social determinants of health.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eExamining social determinants of health factors showed that women with GDM were at higher risk of endorsing social isolation as compared with women with PGDM. People with low social connection are more likely to delay seeking medical care.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Additionally, social isolation and loneliness are linked to increased mortality\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and studies using social capital and neighborhood deprivation as markers for low social connection saw significantly increased rates of GDM.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e However, increased rates of T2DM are also associated with social isolation and loneliness.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e We encourage future research on this important factor.\u003c/p\u003e\u003cp\u003eWhile our study moves the field forward by comparing metabolically similar patients and including a breadth of measured covariates, there are important limitations to consider. First, many PHQ9 scores were not recorded within the patient electronic medical record. We are unsure if this was due to zero scores and therefore the provider did not enter a score or if the standard screener was not given to the patient. Second, at our hospital, the Edinburgh Postnatal Depression Scale may be used as an alternative to the PHQ9.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e There were a total of 34 2-week and 17 6-week Edinburgh Postnatal Depression Scores in our sample though none of these scores were recorded for women without PHQ9 scores. Therefore, we did not utilize the Edinburgh Postnatal Depression Scale information. Third, it may have been the case that while delivery occurred at our hospital, the patient received psychological care elsewhere and their diagnosis is not reflected in our data. In addition, previous work has suggested associations between antipsychotic medication and risk for GDM.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e While the confounding here may be limited due to the decreased likelihood of taking an antipsychotic prescription during pregnancy, future research should consider investigating the role of including psychiatric medications. Finally, though DM type and diagnosis was reviewed by hand, there are still inherent human errors in electronic medical records that are translated into study data.\u003c/p\u003e\u003cp\u003eEarly and continuous screening for pregnancy and postpartum mental health disorders are warranted to prevent adverse events in the mother and child. Targeted interventions may be beneficial in certain populations including those with PGDM. Psychological interventions that specifically address the needs of pregnant and postpartum women with DM, perhaps that additionally target behavioral health changes in nutrition and glycemic control, may be beneficial for the management of both DM and mental health issues.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, individuals with PGDM were at higher risk for postpartum psychiatric diagnosis, as well as several adverse birth outcomes and comorbidities, as compared to GDM. The relation between diabetes type and postpartum psychiatric diagnosis was fully attenuated with the inclusion of HbA1c. Our study shows important differences between DM type experienced during pregnancy which may be important to consider in patient care. More research into the biological link between DM and mental health is warranted as HbA1c levels are manageable.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ediabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGDM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003egestational diabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHbA1c\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eglycated hemoglobin\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eneonatal intensive care unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePGDM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epregestational diabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePHQ9\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePatient Health Questionnaire 9-question\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eT1DM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003etype 1 diabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eT2DM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003etype 2 diabetes mellitus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the University of Illinois, Chicago Institutional Review Board (#2022\u0026thinsp;\u0026minus;\u0026thinsp;1045) and was determined to be \u0026ldquo;exempt\u0026rdquo; with a waiver for participant consent in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA waiver of consent was granted from the University of Illinois, Institutional Review Board (#2022\u0026thinsp;\u0026minus;\u0026thinsp;1045).\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe project described was supported by the National Center for Advancing Translational Sciences (NCATS) National Institutes of Health, through Grant Award UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We have no other sources of financial support to report.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eQ.C. designed the study. A.S. hand-reviewed and cleaned the data. A.S. performed a literature review. Q.C. performed the statistical analysis. Q.C. and A.S. interpreted the results. Q.C. and A.S. wrote the manuscript and approved the final version.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe acknowledge the patients and providers at the University of Illinois Health.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Diabetes Statistics Report | Diabetes | CDC, June. 29, 2022. Accessed March 5, 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/diabetes/data/statistics-report/index.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/diabetes/data/statistics-report/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDiabetes During Pregnancy | Maternal Infant Health | Reproductive Health | CDC, January. 16, 2019. Accessed March 5, 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-during-pregnancy.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/reproductivehealth/maternalinfanthealth/diabetes-during-pregnancy.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoctor E, Dunne FP. Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria. World J Diabetes. 2015;6(2):234\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4239/wjd.v6.i2.234\u003c/span\u003e\u003cspan address=\"10.4239/wjd.v6.i2.234\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142:S8\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0165-0327(12)70004-6\u003c/span\u003e\u003cspan address=\"10.1016/S0165-0327(12)70004-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Suppl.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Aacute;sbj\u0026ouml;rnsd\u0026oacute;ttir B, Vestgaard M, Do NC, et al. Prevalence of anxiety and depression symptoms in pregnant women with type 2 diabetes and the impact on glycaemic control. Diabet Med. 2021;38(3):e14506. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/dme.14506\u003c/span\u003e\u003cspan address=\"10.1111/dme.14506\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazarpour S, Simbar M, Kiani Z, Khalaji N, Khorrami Khargh M, Naeiji Z. The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study. BMC Psychiatry. 2024;24(1):511. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12888-024-05960-4\u003c/span\u003e\u003cspan address=\"10.1186/s12888-024-05960-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eByford AR, Forbes K, Scott EM. Glucose Treatment Targets in Pregnancy - A Review of Evidence and Guidelines. Curr Diabetes Rev. 2023;19(2):e220422203917. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/1573399818666220422083935\u003c/span\u003e\u003cspan address=\"10.2174/1573399818666220422083935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKan C, Silva N, Golden SH, et al. A Systematic Review and Meta-analysis of the Association Between Depression and Insulin Resistance. Diabetes Care. 2013;36(2):480\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc12-1442\u003c/span\u003e\u003cspan address=\"10.2337/dc12-1442\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePenckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P. Does Glycemic Variability Impact Mood and Quality of Life? Diabetes Technol Ther. 2012;14(4):303\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/dia.2011.0191\u003c/span\u003e\u003cspan address=\"10.1089/dia.2011.0191\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeraets AFJ, K\u0026ouml;hler S, Muzambi R, et al. The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study. Diabetologia. 2020;63(11):2315\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00125-020-05247-9\u003c/span\u003e\u003cspan address=\"10.1007/s00125-020-05247-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHughes RCE, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care. 2014;37(11):2953\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc14-1312\u003c/span\u003e\u003cspan address=\"10.2337/dc14-1312\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarapati J, Jajoo S, Aradhya D, Reddy LS, Dahiphale SM, Patel DJ. Postpartum Mood Disorders: Insights into Diagnosis, Prevention, and Treatment. Cureus 15(7):e42107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.42107\u003c/span\u003e\u003cspan address=\"10.7759/cureus.42107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JBW. The PHQ-9. J GEN INTERN MED. 2001;16:606\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1525-1497.2001.016009606.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1525-1497.2001.016009606.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeeney T, Hartwig FP, Davies NM. How to use directed acyclic graphs: guide for clinical researchers. BMJ. 2025;388:e078226. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj-2023-078226\u003c/span\u003e\u003cspan address=\"10.1136/bmj-2023-078226\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller ES, Peri MR, Gossett DR. The association between diabetes and postpartum depression. Arch Womens Ment Health. 2016;19(1):183\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00737-015-0544-x\u003c/span\u003e\u003cspan address=\"10.1007/s00737-015-0544-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalfr\u0026agrave; MG, Nicolucci A, Bisson T, Bonsembiante B, Lapolla A, QLISG (Quality of Life Italian Study Group). Quality of life in pregnancy and post-partum: a study in diabetic patients. Qual Life Res. 2012;21(2):291\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11136-011-9940-5\u003c/span\u003e\u003cspan address=\"10.1007/s11136-011-9940-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHall M, Oakey H, Penno MAS, et al. Mental Health During Late Pregnancy and Postpartum in Mothers With and Without Type 1 Diabetes: The ENDIA Study. Diabetes Care. 2022;45(5):1082\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc21-2335\u003c/span\u003e\u003cspan address=\"10.2337/dc21-2335\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T. Pregnancy complications, mental health-related problems and type 2 diabetes mellitus in Malaysian women. Diabetes Metab Syndr. 2013;7(4):191\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.dsx.2013.10.023\u003c/span\u003e\u003cspan address=\"10.1016/j.dsx.2013.10.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRiggin L. Association Between Gestational Diabetes and Mental Illness. Can J Diabetes. 2020;44(6):566\u0026ndash;e5713. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcjd.2020.06.014\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjd.2020.06.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu X, Wang S, Wang G. Prevalence and Risk Factors of Postpartum Depression in Women: A Systematic Review and Meta-analysis. J Clin Nurs. 2022;31(19\u0026ndash;20):2665\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jocn.16121\u003c/span\u003e\u003cspan address=\"10.1111/jocn.16121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArafa A, Dong JY. Gestational diabetes and risk of postpartum depressive symptoms: A meta-analysis of cohort studies. J Affect Disord. 2019;253:312\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jad.2019.05.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2019.05.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eField C, Lynch CD, Fareed N, et al. Association of community walkability and glycemic control among pregnant individuals with pregestational diabetes mellitus. Am J Obstet Gynecol MFM. 2023;5(5). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajogmf.2023.100898\u003c/span\u003e\u003cspan address=\"10.1016/j.ajogmf.2023.100898\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReisinger MW, Moss M, Clark BJ. Is lack of social support associated with a delay in seeking medical care? A cross-sectional study of Minnesota and Tennessee residents using data from the Behavioral Risk Factor Surveillance System. BMJ Open. 2018;8(7):e018139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2017-018139\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2017-018139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu B. Social disconnection and mortality: new evidence for old truths. Trends Cogn Sci. 2023;27(10):890\u0026ndash;1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.tics.2023.08.001\u003c/span\u003e\u003cspan address=\"10.1016/j.tics.2023.08.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMizuno S, Nishigori H, Sugiyama T, et al. Association between social capital and the prevalence of gestational diabetes mellitus: An interim report of the Japan Environment and Children\u0026rsquo;s Study. Diabetes Res Clin Pract. 2016;120:132\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.diabres.2016.07.020\u003c/span\u003e\u003cspan address=\"10.1016/j.diabres.2016.07.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu EF, Ferrara A, Sridhar SB, Greenberg MB, Hedderson MM. Association Between Neighborhood Deprivation in Early Pregnancy and Gestational Diabetes Mellitus. Obstet Gynecol. 2024;144(5):670\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/AOG.0000000000005521\u003c/span\u003e\u003cspan address=\"10.1097/AOG.0000000000005521\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoneliness increases the risk of type 2 diabetes: a 20 year follow-up - results from the HUNT study - PubMed. Accessed March 20. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/36168066/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/36168066/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHackett RA, Hudson JL, Chilcot J. Loneliness and type 2 diabetes incidence: findings from the English Longitudinal Study of Ageing. Diabetologia. 2020;63(11):2329\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00125-020-05258-6\u003c/span\u003e\u003cspan address=\"10.1007/s00125-020-05258-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gestational diabetes, perinatal mental health, postpartum depression, type 1 diabetes mellitus, type 2 diabetes mellitus","lastPublishedDoi":"10.21203/rs.3.rs-7032300/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7032300/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWe examine associations between pregestational Type 1 or Type 2 diabetes mellitus (PGDM) versus gestational diabetes mellitus (GDM) with postpartum psychopathology.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 6,186 pregnancies, 111 (3%) experienced PGDM and 871 (23%) GDM. Patients with PGDM showed higher rates of cesarean delivery [X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1)\u0026thinsp;=\u0026thinsp;9.30, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01], NICU stay [X\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;21.65, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001], and MICU stay [X\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;7.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01] and higher maximum HbA1c values [7.14 +/- 1.67 mmol/mol versus 6.18 +/- 1.49 mmol/mol; t(304)\u0026thinsp;=\u0026thinsp;9.92, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01] as compared to those with GDM. Low social connections, a measured social determinant of health, was higher for patients with GDM (X\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e (1)\u0026thinsp;=\u0026thinsp;6.97, p\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;=\u0026thinsp;2.40, 95% CI 1.55\u0026ndash;3.73). However, when HbA1c was included in the model, the elevated risk was eliminated (OR\u0026thinsp;=\u0026thinsp;1.03, 95% CI 0.35\u0026ndash;3.04).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAs 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.\u003c/p\u003e","manuscriptTitle":"Associations between prenatal diabetes mellitus, social determinants of health, and postpartum psychopathology: A retrospective review within women with diabetes mellitus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 09:37:15","doi":"10.21203/rs.3.rs-7032300/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-31T18:53:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-31T18:48:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-16T05:28:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-15T16:58:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-07-15T15:40:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"527afd57-42d2-482f-84ce-8db8f51d2e77","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-06T09:37:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-06 09:37:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7032300","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7032300","identity":"rs-7032300","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}