Association of Gestational Diabetes Mellitus and Perinatal Maternal Depression with Child Behavioral Outcomes

• In Event: Perinatal Maternal Depression: Links to Early Childhood Psychological Adjustment and the Role of Father Involvement

Abstract

Prior research has demonstrated associations between gestational diabetes mellitus (GDM) and perinatal maternal depression. However, studies have not examined if co-morbid GDM and perinatal depression affect child behavioral outcomes. The current analysis included 2,379 children aged 4.12±0.60 (48.4% female; 46.8% White; 22.8% Hispanic) in the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program. Analyses consisted of linear regressions to estimate independent and joint effects of GDM, prenatal maternal depression, and postnatal maternal depression on child externalizing problems, internalizing problems, and autism behaviors on the child behavior checklist (CBCL) preschool version. Covariates included race, ethnicity, age, education, hypertension, pre-pregnancy BMI, delivery mode, preterm delivery, and age at assessment.

Simple main effects of GDM and prenatal and postnatal maternal depressive symptoms on child externalizing problems were observed in the adjusted model (F [15, 2363]=16.99, p<.0001, adj. R2=0.09). GDM (β=1.86±0.69), prenatal maternal depressive symptoms (β=0.19±0.03), and postnatal maternal depressive symptoms (β=0.21±0.03) were each associated with increased child externalizing problems. Post-hoc analyses stratified by child sex revealed an association between in utero exposure to GDM and externalizing problems in male children (β=2.29±0.94), but not female children (β=0.59±1.07). Prenatal and postnatal maternal depressive symptoms remained predictors of externalizing problems in both male and female children.

Main effects of GDM and prenatal and postnatal maternal depressive symptoms on child internalizing problems were found in the adjusted model (F [15, 2363]=27.48, p<.0001, adj. R2=0.14). GDM (β=1.50±0.71), prenatal maternal depressive symptoms (β=0.22±0.03), and postnatal maternal depressive symptoms (β=0.22±0.03) were each associated with increased child internalizing problems. Similarly, post-hoc analyses stratified by child sex revealed an association between in utero exposure to GDM and internalizing problems in male children (β=1.89±0.94), but not female children (β=0.99±1.10). Prenatal and postnatal maternal depressive symptoms remained predictors of internalizing problems in both male and female children.

Linear regression models showed a significant interaction between GDM, prenatal, and postnatal maternal depressive symptoms with autism related problems in adjusted analyses (F(19, 2359)=12.21, p< 0001, adj. R2=0.08). To better interpret the interaction effect of GDM and prenatal and postnatal maternal depressive symptoms on child autism spectrum problems, we stratified by maternal GDM status. Among children of women without GDM, both prenatal maternal depressive symptoms (β=0.08±0.02) and postnatal maternal depressive symptoms (β=0.09±0.02) were each associated with increased child autism spectrum problems. Among children of women with GDM, only prenatal maternal depressive symptoms were associated with increased child autism spectrum problems (β=0.17±0.08).

Our findings suggest sexually dimorphic effects of GDM on child behavioral outcomes. Future studies should attempt to identify biological mechanisms underlying resiliency in females exposed to GDM in utero due to the lack of associations with subsequent behavioral problems in the current analyses. Additionally, since both GDM and prenatal maternal depression are associated with increased inflammatory processes and HPA-axis upregulation during pregnancy, identification of the interactions among underlying biological mechanisms is needed to mitigate adverse neurobehavioral outcomes. Further understanding of mechanisms may inform prophylactic programs during pregnancy with the potential to be translated into strategies that improve long-term child behavioral outcomes.

Group Authors

on behalf of the Environmental Influences on Child Health Outcomes (ECHO) program

Authors

• Lauren Shuffrey, Columbia University
  Presenting Author

• Santiago Morales, University of Southern California

• Melanie Jacobson

• Michelle Bosquet Enlow, Boston Children's Hospital

• Akhgar Ghassabian, New York University School of Medicine

• Amy Margolis, Columbia University

• Maristella Lucchini

• Arielle R Deutsch, Avera Research Institute

• William P Fifer, Columbia University

• W. Alex Mason, The University of Tennessee Health Science Center

• Thomas G O'Connor, University of Rochester Medical Center

• Kecia Carroll

• Rosa Crum

• Dana Dabelea

• Christine Hockett

• Lisette Jacobson

• Nicolo Pini

• Yael Rayport

• Ayesha Sania

• Leonardo Trasande

• Rosalind Wright

• Seonjoo Lee

• Catherine Monk, Columbia University Irving Medical Center