Association Between Preexisting Diabetes in Pregnancy and Maternal Mental Health Outcomes: A Systematic Review and Meta‐Analysis

Aim To synthesize evidence on the association between preexisting diabetes in pregnancy and maternal mental health outcomes during and after pregnancy. Methods We searched PubMed, CINAHL, Psychology and American Psychological Association (APA PsycArticles), and preprints until March 2024. We included observational studies that reported adjusted effect sizes for the association between preexisting diabetes and maternal mental health outcomes in pregnancy. After data extraction and quality assessment, a bias‐adjusted inverse variance heterogeneity model was used to synthesize adjusted odds ratios and their corresponding 95% confidence intervals. Heterogeneity was assessed using I 2 and publication bias using funnel plots. The quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Eight studies, comprising over 1.37 million participants, from the USA, Sweden, Denmark, and Finland, were analyzed. In overall synthesis, preexisting diabetes in pregnancy was associated with higher odds of antepartum and postpartum depression (OR 1.36, 95% CI 1.05–1.78, I 2 = 39.5%) with moderate GRADE certainty evidence. The effect of preexisting diabetes was higher in studies that focused only on postpartum depression (OR 1.78, 95% CI 1.09–2.9, I 2 = 0%) compared to those that combined both antepartum and postpartum depression (OR 1.31, 95% CI 0.96–1.8, I 2 = 49%). Conclusion Women with preexisting diabetes in pregnancy have higher odds of antepartum and postpartum depression. More robust studies, especially from low‐ and middle‐income countries, are needed.