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Pre-pregnancy diabetes and perinatal mental illness: a population-based latent class analysis

Brown HK, Cairncross ZF, Lipscombe LL, Wilton AS, Dennis CL, Ray JG, Guttmann A, Vigod SN. Am J Epidemiol. 2019; Nov 12 [Epub ahead of print].

We examined the risk of any perinatal mental illness associated with pre-pregnancy diabetes and identified how diabetes duration, complexity, and intensity of care affect this risk. We performed a population-based study of 15 to 49-year-old women with (n=14,186) and without (n=843,818) pre-pregnancy diabetes who had a singleton livebirth (Ontario, Canada, 2005-2015) and no recent mental illness. Modified Poisson regression estimated perinatal mental illness risk between conception and 1 year postpartum in women with vs. without diabetes and in diabetes groups, defined by a latent class analysis of diabetes duration, complexity, and intensity of care variables, vs. women without diabetes. Women with diabetes were more likely than those without to develop perinatal mental illness (18.1% vs. 16.0%; adjusted relative risk: 1.11; 95% confidence interval: 1.07, 1.15). Latent classes of women with diabetes were: uncomplicated and not receiving regular care (59.7%); complicated, with longstanding diabetes, and receiving regular care (16.4%); and recently diagnosed, with comorbidities, and receiving regular care (23.9%). Perinatal mental illness risk was elevated in all classes vs. women without diabetes (adjusted relative risks: 1.09 to 1.12), but class 2 was non-significant after adjustment. Women with diabetes could benefit from preconception and perinatal strategies to reduce their mental illness risk.