Exposure to Maternal Diabetes Linked to Heightened Risk of Depression, Anxiety

New data suggests exposure to maternal diabetes in utero could be linked to an increased risk of depression and anxiety among offspring later in life.

Results of the study, which examined all births occurring during a 20-year period, indicated exposure to type 1 diabetes, type 2 diabetes, or gestational diabetes mellitus were associated with an increase in risk of depression and anxiety among offspring. However, investigators called attention to considerable heterogeneity in these associations, with the greatest magnitude of risk observed in those requiring antidiabetes medications.¹

“Our results provide valuable insight into the relationship between diabetic pregnancy and risk of developing depression or anxiety in off-spring. We found that the risk was only elevated for the subgroup of children with mothers with pre-existing [type 1 diabetes], [type 2 diabetes] or [gestational diabetes mellitus] that required antidiabetic medication treatment during pregnancy,” wrote investigators.¹

As the prevalence of diabetes continues to increase in the US,² a greater understanding of the effect of maternal glycemic control and disease management might have on offspring. In the current study, Sarah Carter, PhD, of Kaiser Permanente Southern California, along colleagues from UCLA and USC designed the current study with the intent of estimating the effects of maternal diabetes, stratified according to diabetes type, on depression or anxiety diagnosis among offspring later in life.¹

To do so, investigators leveraged electronic medical records obtained from Kaiser Permanente Southern California (KPSC) hospitals. With 1995 to 2015 as a period of interest, investigators identified 439,590 offspring for inclusion in their study. For the purpose of analysis, children were followed from age 5 until the first of the following: date of clinical diagnosis of depression or anxiety, last date of continuous KPSC,death from any cause, or December 31, 2020.¹

Overall, 11.3% (n=49,736) were exposed to maternal diabetes in utero, with 680 exposed to type 1 diabetes, 6636 exposed to type 2 diabetes and 42,420 exposed to gestational diabetes mellitus. Upon analysis, 439,590 offspring included in the study, including 6.8% (n=29,891) with a diagnosis of depression and 11.8% (n=51,198) with a diagnosis of anxiety.¹

Compared to their counterparts without exposure to maternal diabetes, adjusted analyses suggested an increased risk of depression was observed for type 1 diabetes(adjusted Hazard Ratio [aHR], 1.44; 95% Confidence Interval [CI], 1.09-1.91), type 2 diabetes (aHR, 1.30; 95% CI, 1.15-1.47), and gestational diabetes mellitus requiring medications. However, investigators highlighted this apparent increase in risk was not observed for when assessing risk among those with type 2 diabetes (aHR, 0.97; 95% CI, 0.82-1.15) and gestational diabetes mellitus (aHR, 0.99; 95% CI 0.94-1.04) who were not using antidiabetes medications.¹

When assessing risk of anxiety, investigators noted similar trends were observed when assessing for risk of anxiety. Additionally, subgroup analysis further stratifying children according to age suggested significant associations were observed for offspring ages 5 to 12 years and 12 to 18 years, but these were attenuated among the subgroup aged 18 to 25 years.¹

Investigators called attention to multiple liitations within their study for clinicians to consider. These included the retrospective nature of data used in analyses as well as risk of potential confounding because paternal risk factors were not evaluated and inability to adjust for intrauterine exposures to other medications.¹

“To our knowledge, this is the first study that comprehensively evaluated depression and anxiety risk in offspring associated with the three main types of diabetes complicating pregnancy and assessed timing of exposure by using gestational age of gestational diabetes mellitus diagnosis and antidiabetic medication treatment during pregnancy,” investigators wrote.¹

References:

1. Xiang AH, Lin JC, Chow T, et al. Types of diabetes during pregnancy and risk of depression and anxiety in offspring from childhood to young adulthood [published online ahead of print, 2023 Oct 12]. Diabetes Obes Metab. 2023;10.1111/dom.15308. doi:10.1111/dom.15308
2. Campbell P. Rates of type 1, type 2 diabetes expected to balloon in US by 2060. HCP Live. January 12, 2023. Accessed October 20, 2023. https://www.hcplive.com/view/rates-of-type-1-type-2-diabetes-expected-to-balloon-in-us-by-2060.