Neonatal outcomes and its association among gestational diabetes mellitus with and without depression, anxiety and stress symptoms in Malaysia: A cross-sectional study
Introduction
Studies have reported that gestational diabetes mellitus (GDM) markedly increases the risk for adverse neonatal outcomes (Kjos and Buchanan, 1999). This is a worrying condition as GDM is one of the more commoner medical disorders during pregnancy and the prevalence of GDM worldwide is now about 7.0% (Seshiah et al., 2006) and even higher in Asia (11.5%) (Lee et al., 2018).
Studies reported that those mothers with GDM are at risk of having macrosomia, preterm delivery, congenital anomalies and birth injuries (Banhidy et al., 2010; Capula et al., 2013; Deryabina et al., 2016; Esakoff et al., 2009; Hosseini et al., 2018; Kamanu et al., 2009; Kong et al., 2015; Mane et al., 2018; Mitrovic et al., 2014; Mortier et al., 2017; Srichumchit et al., 2015; Tellapragada et al., 2016; Tuuli et al., 2016). The prevalence of preterm delivery in neonates born to GDM mothers ranged from 6.5% to as high as 17.4% (Kim et al., 2018; Zhang et al., 2014). GDM increases the odds (OR = 1.18–2.91) for preterm delivery when compared to those without GDM (Srichumchit et al., 2015; Tellapragada et al., 2016). Abnormal birth weight were also noted to be common among neonates born to GDM mothers. The prevalence of macrosomia in neonates born to GDM mothers ranged from 2.5% to a massive 32.2% (Kamanu et al., 2009; Tuuli et al., 2016) and the prevalence of low birth weight among neonates born to GDM mothers ranged from 7.5% to as high as 47.6% (Deryabina et al., 2016; Hosseini et al., 2018). Neonates born to GDM mothers are at increased risk for adverse neonatal outcomes. Likewise, the prevalence of congenital anomalies among neonates born to GDM mother ranged from 0.5% to 12.2% (Banhidy et al., 2010; Mitrovic et al., 2014; Srichumchit et al., 2015), hypoglycaemia (ranged from 1.6% to 35.3%) (Kong et al., 2015; Mane et al., 2018), hyperbilirubinaemia (ranged from 2% to 63.3%) (Aktün et al., 2015; Mitrovic et al., 2014), hypocalcemia (ranged from 1.2% to 2.7%) (Capula et al., 2013; Mane et al., 2018) and neonatal respiratory distress (ranged from 2.8% to 20%) (Esakoff et al., 2009; Mortier et al., 2017).
Certain psychological distress especially depression, anxiety and stress that may be encountered by pregnant mother may contribute to adverse neonatal outcomes. (Acs et al., 2006; Liou et al., 2016; Stylianou-Riga et al., 2018). For instance, preterm delivery was found to be associated with both maternal depression (OR = 1.38) (Stylianou-Riga et al., 2018) and maternal stress (OR = 8.5) (Stylianou-Riga et al., 2018). A study also reported that neonatal congenital anomalies was associated with the presence of maternal anxiety in pregnancy (OR = 3.0) (Acs et al., 2006). On the other hand, other studies provided a rather inconsistent findings that low birth weight was associated with the presence of maternal anxiety (OR = 1.19) and stress (OR = 1.08) but was not associated with the presence of maternal depression (OR = 0.88) (Liou et al., 2016). Studies had reported that socioeconomic disadvantage, presence of many stressors and adverse health conditions were probably indirect etiologic determinants that may be mediated through psychosocial distress and subsequently cause adverse neonatal outcomes (Dunkel Schetter, 2011; Istvan, 1986; Rini et al., 1999).
Therefore, the aim of this study was to determine the prevalence of neonatal outcomes and its association among mothers with gestational diabetes mellitus with and without the presence of depression, anxiety and stress symptoms in Malaysia.
Section snippets
Study design and setting and population
This was a sub-analysis of a cross-sectional study that examines prevalence of neonatal outcomes of GDM mothers who delivered their neonates at two tertiary hospitals in Malaysia (Hospital Kuala Lumpur and Hospital Serdang). The GDM mothers (n = 526) were initially recruited by using a systematic random sampling method and the sample size needed was 524 with 99% power, a 95% confidence interval (CI), after considering a non-response rate of 30%. The sample size was calculated using the Lemeshow
Findings
At the end of the study, out of 526 GDM mothers, 418 GDM mothers were recruited into the final analysis. We excluded GDM mothers in whom their neonates were born stillbirth (n = 3) and those delivered elsewhere from the two hospitals listed above (n = 105).
Discussion
Our study reports that the prevalence of adverse neonatal outcomes stood at 14.6% for low birth weight, followed by preterm delivery (9.1%) and macrosomia (4.8%) in neonates born to GDM mothers. Besides that, 10.5% of neonates born to GDM mothers had metabolic and electrolyte disorders, followed by neonatal respiratory distress (5.8%) and congenital anomalies (2.4%). Besides that, our study also found a significant association between neonatal respiratory distress and the presence of depression
Conclusion
The finding from this study demonstrates the positive association of adverse neonatal outcomes with the presence of depression symptoms in GDM mothers. It is therefore important to identify depression symptoms early after a diagnosis of GDM in pregnant mothers is confirmed to allow for early referral and interventions in order to reduce many undesired adverse neonatal effects.
Ethics approval and consent to participate
The ethics approval was obtained from the Medical Research Ethics Committee (MREC), Ministry of Health Malaysia (NMRR-17-2264-37814). Written consent was obtained from the respondents prior to the data collection.
Funding sources
This research received its funding from the Universiti Putra Malaysia under Putra Graduate Initiative (UPM/700-2/1/GP-IPS/2018/9593800), High Impact Grant (UPM/800-3/3/1/GPB/2018/9659600) and Graduate Research Fellowship (UPM/SPS/GS48750). The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
CRediT authorship contribution statement
Kai Wei Lee: Conceptualization, Data curation, Formal analysis, Writing - original draft, Writing - review & editing. Siew Mooi Ching: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Fan Kee Hoo: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Vasudevan Ramachandran: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Seng Choi Chong: Data curation, Formal analysis, Writing
Declaration of Competing Interest
The authors declare that they have no competing interests.
Acknowledgements
We gratefully acknowledge the Medical graduate (Dr Man Jun Soo, Dr Inas Deuraseh and Dr Hilman Adrees Khairul Annuar), medical and administrative staff at the Hospital Kuala Lumpur and Hospital Serdang for their assistance. We would like to extend our thanks to all mothers with GDM for participating in this study.
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