Oral Presentation Australian Diabetes in Pregnancy Society 2018

Women with childhood trauma who develop depression prior to pregnancy are at increased risk of developing gestational diabetes (#6)

Danielle AJM Schoenaker 1 2 , Gita D Mishra 3 , Leonie K Callaway 4 5
  1. Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC, Australia
  2. Discipline of Obstetrics and Gynaecology, Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
  3. School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  4. UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  5. Obstetric Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia

Aims: Growing evidence suggests that health and behavioural factors during early life and before conception may contribute to risk of developing gestational diabetes mellitus (GDM). Women’s childhood psychosocial environment has been shown to influence diabetes risk in non-pregnant populations, but the impact on GDM risk remains unclear. This study sought to examine if the number and type of traumatic experiences in childhood are associated with future GDM risk.

Methods: The study included 6,317 women participating in the Australian Longitudinal Study on Women’s Health who were followed from 1996 (age 18-23) until 2015. GDM diagnosis was reported for all pregnancies (N = 11,556). Exposure to eight adverse childhood experiences (ACEs), including abuse and household dysfunction, were recalled. Log-binomial regression models with generalised estimating equations were used to estimate relative risks (RR) and 95% CI. Analysis were adjusted for early life, preconception and antenatal GDM risk factors. Effect modification by preconception mental health was tested using cross-product terms.

Results: Women exposed to a higher number of ACEs were more likely to have lower education, and poorer lifestyle and physical and mental health prior to pregnancy. GDM occurred in 4.7% of pregnancies. Compared with no exposure to ACEs, exposure to any three or more ACEs (6% of women, RR 1.73 [95% CI 1.02, 3.01]) or four or more ACEs (7%, 1.76 [1.04, 2.99]) was associated with elevated GDM risk among women with preconception depressive symptoms, independent of early life, preconception and antenatal risk factors. Out of the eight adverse events examined, physical abuse and household substance abuse were associated with higher GDM risk. Exposure to ACEs did not influence GDM risk among women without depressive symptoms prior to pregnancy (P-value for interaction=0.01).

Conclusions: Our findings suggest that, in addition to primary prevention of childhood adversity, strategies to curb poor mental health trajectories into adulthood among women who grew up in stressful environments should be considered when developing programs for the prevention of GDM.