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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Relationship between depression and diabetes in pregnancy: A systematic review
Glynis P Ross, Henrik Falhammar, Roger Chen, Helen Barraclough, Ole Kleivenes, Ian Gallen
Glynis P Ross, Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia
Glynis P Ross, Department of Endocrinology, Bankstown-Lidcombe Hospital, Sydney, New South Wales 2200, Australia
Glynis P Ross, Roger Chen, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
Henrik Falhammar, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SE 171 76, Sweden
Henrik Falhammar, Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, SE 171 76, Sweden
Henrik Falhammar, Menzies School of Health Research, Royal Darwin Hospital, Darwin, Northern Territory 0811, Australia
Roger Chen, Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, Sydney, New South Wales 2139, Australia
Helen Barraclough, Ole Kleivenes, Lilly Diabetes, Eli Lilly Australia and New Zealand, West Ryde, New South Wales 2114, Australia
Ian Gallen, Diabetes and Endocrinology, Royal Berkshire Foundation Trust, Reading, Berkshire RG1 5BS, United Kingdom
Author contributions: All authors participated in the design of the literature search strategy and eligibility criteria, approved the eligible references for inclusion in the review, reviewed and interpreted the extracted data from each publication, and were involved in the drafting, critical revision, and approval of the final version of the manuscript.
Conflict-of-interest statement: Glynis P Ross has received financial support from AMSL, Medtronic, Eli Lilly, NovoNordisk, Sanofi, Novartis, and Merck Sharp and Dohme for the independent development and delivery of lectures; Henrik Falhammar has received research funding from the Magn. Bergvalls Foundation, Karolinska Institutet, and Stockholm County Council, and financial support from Boehringer Ingelheim, AstraZeneca, Merck Sharp and Dohme, Sanofi, NovoNordisk, and Ipsen for delivery of lectures; Roger Chen has received financial support from and/or served on advisory boards for Novo Nordisk, Merck Sharp and Dohme, Novartis, AstraZeneca, and Janssen Cilag, and received an educational grant from Boehringer Ingelheim; Helen Barraclough is an employee of, and Ole Kleivenes is a former employee of, Eli Lilly Australia and New Zealand; Ian Gallen has received speaker fees from Eli Lilly and NovoNordisk, and provides educational events for patients and healthcare professionals, funded by Animas Corporation and Eli Lilly, respectively.
Data sharing statement: This article is a systematic review of the literature and did not include a meta-analysis; as such, all reported data are derived from the published articles and data sharing is not relevant.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ian Gallen, Diabetes and Endocrinology, Royal Berkshire Foundation Trust, Melrose House, 71 London Road, Reading, Berkshire RG1 5BS, United Kingdom. ian.gallen@royalberkshire.nhs.uk
Telephone: +44-1183-227965 Fax: +44-1183-228810
Received: February 4, 2016
Peer-review started: February 14, 2016
First decision: April 15, 2016
Revised: May 20, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: November 15, 2016
AIM
To systematically review the literature on women with both diabetes in pregnancy (DIP) and depression during or after pregnancy.
METHODS
In this systematic literature review, PubMed/MEDLINE and EMBASE were searched (13 November 2015) using terms for diabetes (type 1, type 2, or gestational), depression, and pregnancy (no language or date restrictions). Publications that reported on women who had both DIP (any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance.
RESULTS
Of 1189 articles identified, 48 articles describing women with both DIP and depression were included (sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies (mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP (any type) and depression in general populations of pregnant women ranged from 0% to 1.6% (median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80% (median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression.
CONCLUSION
Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.
Core tip: Depression in women with diabetes in pregnancy (DIP) may be increasingly common. We identified 48 studies of depression and DIP, of variable and often poor quality. The prevalence of concurrent DIP and depression ranged from 0% to 1.6% (median 0.61%; 12 studies). Among women with gestational diabetes, the prevalence of depression ranged from 4.1% to 80% (median 14.7%; 16 studies). There was no clear consensus on whether DIP was a risk factor for depression. Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.
