Perinatal & Pediatric
The risk of adverse birth outcomes in mothers with depressive symptoms comorbid with gestational diabetes or hypertension: The Born in Queensland Study Biruk Beletew Abate* Biruk Abate Abate Abate Abate Abate Abate Curtin University
The risk of adverse birth outcomes in mothers with depressive symptoms comorbid with gestational diabetes or hypertension: The Born in Queensland Study
Abstract
Background: Depression, hypertensive disorders of pregnancy (HDP), and gestational diabetes mellitus (GDM) are common pregnancy complications that often co-occur, but their combined effects remain underexplored. In this study, we aimed to assess the joint impact of antenatal depressive symptoms comorbid with either HDP or GDM on adverse birth outcomes.
Methods: In this population-based retrospective cohort study, we analysed 149,025 mother–child pairs in Queensland, Australia. Eligible participants were all women who gave birth between July 2015 and December 2021 and had recorded scores on the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression models estimated adjusted odds ratios (AORs) for adverse outcomes associated with prenatal depressive symptoms alone or in combination with HDP or GDM. We also assessed potential interaction effects.
Results: Depression, HDP, and GDM were each independently associated with increased risks of adverse birth outcomes. Risks were greatest when depression co-occurred with either HDP or GDM. Depression with HDP was strongly associated with preterm birth (AOR 3·08, 2·70–3·53), LBW (AOR 3·05, 2·62–3·53), neonatal resuscitation (AOR 1·55, 1·40–1·73), congenital anomalies (AOR 1·24, 1·05–1·46), low Apgar score (AOR 1·80, 1·41–2·28), and ICN/SCN admission (AOR 1·85, 1·67–2·06), with risks consistently exceeding those for either condition alone. Similarly, depression with GDM was associated with increased risks of preterm birth (AOR 2·60, 2·27–2·98), LBW (AOR 2·44, 2·10–2·83), neonatal resuscitation (AOR 1·51, 1·36–1·68), congenital anomalies (AOR 1·28, 1·09–1·51), low Apgar score (AOR 1·64, 1·29–2·08), and ICN/SCN admission (AOR 1·94, 1·75–2·16).
Conclusions: Antenatal depression comorbid with HDP or GDM is associated with an increased risk of adverse birth outcomes, exceeding the independent additive effects of each condition, underscoring the need for integrated care. Incorporating mental health into routine obstetric practice and evaluating targeted interventions for high-risk women remain key priorities.
Keywords: Depression, Diabetes, Hypertension, Comorbidity, Neonatal Outcomes