Depression or Anxiety During Pregnancy Could Increase Type 1 Diabetes Risk for Offspring

Catarina Almqvist, MD, PhD
Credit: Karolinska Institutet

New data from an analysis of more than 1.8 million children suggest a mother’s mental health could play a role in risk of type 1 diabetes (T1D) among offspring.

Results of the study, which was conducted by investigators from the Karolinska Institutet in Sweden, suggest maternal depression/anxiety was associated with a more than 20% increase in risk of offspring T1D after, but not before, the age of 8 years, with investigators noting this association for not observed for paternal depression/anxiety.¹

“These findings contribute to identifying maternal stress during pregnancy as a risk factor for offspring T1D and highlight the importance for future research in understanding the pathways through which early-life risk factors impact disease initiation and progression,” investigators wrote.¹

In recent years, particularly during the COVID-19 pandemic, the subject of mental health and diabetes have become a major talking point both in and out of the medical community. According to the US Centers for Disease Control and Prevention, people with diabetes are 2-3 times more likely to have depression than people without diabetes, but only 25-50% of people with diabetes who have depression get diagnosed and treated.²

In the current study, a team from Karolinska Institutet led by Catarina Almqvist, MD, PhD, a professor in clinical epidemiology and consultant pediatrician, sought to investigate potential associations between maternal depression/anxiety during pregnancy and offspring T1D, specifically the impact of exposure during pregnancy. To do so, investigators designed their study as an analysis of data from national registries in Sweden for the period 2002-2019.¹

Investigators identified 1,807,809 offspring born in the aforementioned time period. All of these patients had information available related to diagnosis or medication prescription for depression/anxiety in and around pregnancy as well as information related to diagnosis of T1D or insulin treatment.¹

During a mean follow-up of 8.6 years 0.5% (n=8182) children developed T1D, with a mean age at onset of 7.9 (SD, 4.1) years. Initial analysis revealed 6.3% (n=113,068) offspring were exposure to maternal depression/anxiety during pregnancy and 11.1% (n=200,220) were exposures any time from before to after pregnancy.¹

For the purpose of analysis, associations were estimated using flexible parametric and Cox regression models, with familial confiding addressed using paternal exposure as a negative control and comparing offspring exposed to maternal depression/anxiety with their unexposed siblings. Investigators pointed out offspring outcomes were classified using ICD-10 or A10A codes, with date of disease onset considered the date of diagnosis or, if missing, the date of the first insulin prescription. Investigators noted maternal or paternal depression/anxiety was defined as any diagnosis for mood- or anxiety-related disorders using ICD-10 codes, with the primary exposure period defined as 90 days before conception up until delivery.¹

Upon analysis, results suggested exposure to maternal depression/anxiety was associated with an increased his of offspring T1D onset after 8 years of age (adjusted hazard ratio [aHR], 1.21 [95% CI, 1.03-1.42]), but this association was not observed before 8 years of age. Subgroup analyses suggested exposure to maternal depression/anxiety occurring only during pregnancy was associated with increased risk of offspring T1D (aHR, 1.24 [95% CI, 0.96-1.60]), but this association was not present among mothers with depression/anxiety only before pregnancy (aHR, 0.91 [95% CI, 0.64-1.30]).¹

Investigators also highlighted specific results indicating associations were close to null for paternal depression/anxiety (aHR, 0.95 [95% CI, 0.72-1.25]) and point estimates were above 1 in sibling comparisons (aHR, 1.36 [95% CI, 0.82-2.26]).¹

“These results emphasize the importance of the environmental early- life origins of T1D,” investigators wrote.¹ “Continued research aiming to further understand the mechanisms through which stress during pregnancy, particularly related to symptoms, severity and treatment of maternal psychiatric illness, may contribute to the development of offspring T1D, alongside replication of our findings in other settings, is warranted.”

References:

1. Smew AI, Lundholm C, Gong T, et al. Maternal depression or anxiety during pregnancy and offspring type 1 diabetes: a population-based family-design cohort study. BMJ Open Diabetes Res Care. 2023;11(2):e003303. doi:10.1136/bmjdrc-2023-003303
2. Diabetes and mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/mental-health.html. Published November 3, 2022. Accessed May 4, 2023.