Analysis of influencing factors of postpartum depression in patients with gestational diabetes mellitus and construction of prediction model

Abstract

BACKGROUND

Gestational diabetes mellitus (GDM) requires strict dietary management and blood glucose monitoring, which may impose long-term psychological stress during pregnancy and increase the risk of postpartum depression (PPD). However, the psychological impact of gestational glucose indicators and blood glucose control, as well as their predictive value for PPD in patients with GDM, remains insufficiently explored.

AIM

To identify factors associated with PPD in patients with GDM and to construct a prediction model for PPD risk.

METHODS

A cross-sectional survey was conducted among 204 patients with GDM who underwent prenatal checkups and delivered at Suzhou Ninth People’s Hospital between February 2024 and June 2025. At 6 weeks postpartum, PPD symptoms were measured using the Edinburgh PPD Scale, and participants were divided into PPD (52 cases) and non-PPD (152 cases) groups. Group differences were analyzed, and multivariate logistic regression was used to identify factors associated with PPD in patients with GDM. A predictive model was constructed based on various influencing factors and evaluated using goodness-of-fit testing and the area under the receiver operating characteristic curve. Model performance was further validated using K-fold fold cross-validation.

RESULTS

Significant differences between the PPD and non-PPD groups were observed for 2-hour postprandial blood glucose (2hPG) at GDM diagnosis (P = 0.018), blood glucose control during pregnancy (P = 0.012), postpartum maternal-infant separation (P = 0.001), family care (P = 0.001), and social support (P = 0.007). Multivariate analysis identified high 2hPG, poor gestational blood glucose control, postpartum mother-infant separation, low family care, and low social support as independent risk factors for PPD in patients with GDM (all P < 0.05). The predictive model was defined as Logit (P) = 0.508 × 2hPG + 0.687 × gestational blood glucose control + 1.092 × postpartum mother-infant separation + 0.745 × low family care + 0.289 × low social support - 4.766. The goodness-of-fit test showed no evidence of overfitting (χ² = 1.754, P = 0.514). The model’s area under the receiver operating characteristic curve value was 0.840 (95% confidence interval: 0.757-0.912), with a sensitivity of 0.839 and a specificity of 0.825. After 100 rounds of 10-fold cross-validation, the model demonstrated good generalization performance.

CONCLUSION

PPD incidence is high in patients with GDM and is associated with high 2hPG at diagnosis, poor blood glucose control during pregnancy, postpartum mother-infant separation, low family care, and low social support. A predictive model integrating these factors can effectively evaluate PPD risk in patients with GDM.

Keywords: Gestational diabetes; Postpartum depression; Influencing factors; Predictive model; Postprandial blood glucose

Core Tip: Gestational diabetes mellitus adversely affects maternal and neonatal health and predisposes affected women to anxiety, depression, and other negative emotions. This study identifies key factors associated with postpartum depression in patients with gestational diabetes mellitus and constructs a predictive model to support clinical assessment and targeted intervention for reducing postpartum depression risk.