Perceived Stress and Early Postpartum Depressive Symptoms in Women with Recent GDM: Implications for Postpartum Lifestyle Programs

Objectives: To inform the development and adaptation of lifestyle programs to prevent type 2 diabetes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes (GDM). Methods: Participants are from the Balance after Baby Intervention (BABI) study, a two-year randomized clinical trial of a lifestyle program for women with recent GDM conducted in Boston, MA, and Denver, CO between 2016 and 2019. The Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered at an average of 8-weeks postpartum. We defined an EPDS score of ≥ 9 as depressive symptoms and reviewed medical records for medical history. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of postpartum depressive symptoms using multivariable logistic regression and selected the best fit model. Results: Our analysis included 181 women. Thirty-five (19%) scored ≥ 9 on the EPDS. While both perceived stress and whether this was the first pregnancy complicated by GDM were significant in the bivariate analysis, only perceived stress remained a significant predictor of postpartum depressive symptoms in the multivariate regression model (OR 4.34, 95% CI [2.58–7.31]). The effect of first GDM pregnancy was no longer significant in the multivariate model (OR 2.00, 95% CI [0.63–6.33]). Additionally, a mediation model determined that perceived stress fully mediated the effect of first GDM pregnancy on depressive symptoms (Effect ratio, 0.5507/1.5377 = 0.358, p = 0.036). Conclusions for Practice: Perceived stress was predictive of postpartum depressive symptoms in women with recent GDM and was found to mediate the relationship between first pregnancy complicated by GDM and postpartum depressive symptoms. Addressing perceived stress in the early postpartum period may be an important target for future lifestyle programs to maximize diabetes prevention efforts.