What’s the link between Depression and Gestational Diabetes?

Today mental health tops the agendas of medical and social conferences. Many researchers explore depression and anxiety, treatment via antidepressants, pregnancy and Gestational Diabetes. Depression and anxiety present themselves in many forms. Even just 5 years ago, Gestational Diabetes and depression would not have been linked. Lifesaving research conducted in 2019 may have finally connected the dots.

Understanding gestational Diabetes

If you use the curated sections on our Diabetes website, you’ll learn about Gestational Diabetes in more detail. Tou can click here to catch up at any time. Let’s bring you up to speed so the rest of this article makes sense.

Gestational Diabetes occurs when a pregnant woman’s blood sugar levels spike during the pregnancy. The condition usually resolves itself after childbirth. Gestational Diabetes is indicative of Type 2 Diabetes potentially developing in both mother and child later on in life.

Because this condition occurs naturally, meals and cravings need to be managed with care during pregnancy.

Understanding depression and anxiety

Depression and anxiety have many triggers and symptoms. No two people endure the same frequency or intensity of episodes, or manifest their symptoms in the same way. This makes it increasingly difficult to fully diagnose and treat. Of the available treatment methods, South African medical practitioners sometimes prescribe antidepressants.

Many people with anxiety turn to antidepressants to cope with daily stress. Sometimes this option is chosen over exercise, outdoor activities and balanced nutrition. Safety, financial capacity and daily schedules have a lot to do with this decision.

Not everyone can access a nearby gym or afford the membership fees. The majority of South Africa’s population do not live in or around pristine outdoor environments, where they can safely and regularly interact with nature. Many people spend as much as four hours each day, just waiting for and travelling on public transport to and from work. If your schedule is this busy, it’s understandable that you feel stressed or depressed, and why you would opt for antidepressants. These are more easily accessed from your local clinic or family doctor than other treatment options.

Antidepressants and Gestational Diabetes

Two common scenarios appear in our society today. The first being when a woman is on treatment for depression, then falls pregnant. The second being when a pregnant woman develops depression and is placed on antidepressants for treatment. We’re going to talk about each scenario to help you relate to whichever is more appropriate. You can share this article with someone else in your circle who may need to learn about this too.

Depression treatment heading into pregnancy

Marlow (2017) shared her rollercoaster journey of treatment dependency for Depression and Generalised Anxiety Disorder (GAD) since adolescence. Traditionally trained medical doctors encouraged her and her husband to prioritise the health of the baby above all else. This meant discontinuing antidepressants. Wanting nothing more than to be a good mother, and welcome a healthy baby into the world, Marlow obliged.

It took her years of consistent effort to rebuild herself mentally and emotionally, since her childhood GAD diagnosis. Despite this, she braved the decision to cut off antidepressants and tackle her internal challenges without the help of the medicine she’d relied on all those years.

What followed was a period she refers to as an ‘abyss of suicidal tendencies and complete unravelling of [her] personality’.  She regressed more, the longer she abstained from taking her medication. Two years after the initial decision to stop her Depression treatment, Marlow was placed on stronger antidepressants than before.

She admits that other doctors have since advised her of a higher risk to a baby’s health when a pregnant mother is diagnosed with depression. This finding resulted from comparison to the use of light antidepressants for internal chemical balance during a pregnancy.

Marlow (2017) felt that her research was almost too little too late. Wanting to be a mother so badly for the first time drove her to trust in advice which she believed would yield results the soonest. If you can relate, here are a few points to consider. Discuss these with your doctor, nurse or clinic sister if you need more information (and/or when getting a second opinion):

1. Know your status

This applies to more than just your health status as a Diabetic. There are many health conditions with shared or overlapping symptoms. Untreated, one condition can lead to another. Clinical/Chemical depression is absolutely critical to diagnose in time because your state of mind can affect all other aspects of your health.

If you’re battling suicidal thoughts, constantly feeling overwhelmed, unimportant or invisible, visit your doctor, nurse or clinic sister. Knowing if you have depression makes a massive difference to the quality of life you achieve for yourself.

2. Prioritise yourself

A baby’s health heavily depends on the health of the environment of the womb within which it grows. Antidepressants can safely provide a chemically balanced environment in which a baby may healthily develop to full term. The dangers of light antidepressants are far less than the dangers of an increasingly volatile chemical state inside the body of a pregnant mother who is diagnosed with depression.

Depression embeds into the psyche to such an extent that molecular reactions occur at a furious pace within the nervous, endocrine and digestive systems. If you’re planning for a family at the moment, and you’re worried about your depression medication having an effect on the health of your baby, we encourage you to speak to your doctor, nurse or clinic sister as soon as you can. A healthy you is much more likely to result in a healthy baby.

3. Keep learning

Planning a family is a serious and demanding process. Your health, including predispositions to Diabetes, is not always going to be a straightforward issue. Things change, sometimes suddenly, so it’s important to regularly update your doctors, nurses and clinic treatment officers about changes you experience.

If your medication gets changed by one doctor, spend a few seconds telling your other doctors about it. Update some notes once a month in a pocket journal that’s easily accessible in the event of a medical emergency. Always ask the questions that come to mind because you have the right to know what’s happening inside your body.

As you discuss these things with your medical practitioners, you may learn about research, new treatment options, or deeper insights into depression, Diabetes and how to manage a pregnancy with pre-existing health conditions.

During pregnancy, it’s possible to slip into Depression

Within this scenario there are another two common contexts: Depression can intensify during pregnancy or it can appear out of nowhere, at any time between conception and birth, without any indicative medical history. Both situations must be carefully managed for the optimum health of both mother and child.

Undiagnosed Depression

As we discussed earlier in this article, it’s vital for you to know about the status of your health. Depression can occur at any time in your life.. Many cultural and social taboos linger around the formalisation of depression as a medical condition, but the faculties of Science and Medicine both recognise it, and for good reason. Depression, especially if left untreated, can result in major chemical and molecular changes inside your body.

Depression symptoms include the overbearing and persistent feelings of loneliness, emptiness, lack of self-esteem and self-value, lack of confidence, intense feelings of despair and despondency, as well as repeated and often unvoiced yearning for more attention, affection, recognition and praise. This is not to be confused with the principles of narcissism, though: the subconscious hunt for personal power, usually over other people.

Depression is referred to as a silent killer. The endocrine system’s constant release of chemicals like adrenaline, cortisol and other hormones and enzymes can affect the development of a foetus and even cause miscarriage. High frequency, high intensity chemical changes in the bloodstream are extremely dangerous for both mother and baby. Additionally, depression affects eating habits and rituals, smoking, alcoholism, all of which need to be carefully managed for the health of an in-utero baby.

During a typical spell of depression, many women can either experience a tendency to eat excessive amounts of unhealthy (greasy, oily, fatty) foods or completely lose their appetite. These tendencies either provide a foetus with incorrect and insufficient nutrients, or nothing at all.

Uncharted territory during pregnancy

First-time mothers go through an intense emotional experience. Exponential increases of oestrogen in the bloodstream affect the intensity of emotional responses in many ways (OER Services, n.d.). Sometimes GAD gets overlooked as a regular emotional episode caused by pregnancy-related hormonal changes. Because it’s overlooked, neither the pregnant woman nor her family/friends/partner/spouse may consider having a conversation with a medical practitioner about it. The episodes continue, and we work on our assumption, or turn to Google to find out what’s best.

Speaking to your doctor, nurse, or clinic sister is the most important and necessary action to take. Your medical practitioners have a solid understanding of your unique body, medical history and responses to medicines, treatment plans and other substances like food allergens. If you suspect depression is something you need to be treated for, then the best thing to do is talk about it, to your medical team.

You may be referred to a local counsellor or Psychologist, or if you have medical aid then a private practice Psychologist or Psychiatrist may assess you. 

How does all this relate to Gestational Diabetes?

Earlier in this article we highlighted that health conditions can be complex and interrelated. Antidepressants, like with many other medicines, have natural or synthetic formulae options and respective side effects. Allen (2011) breaks down how antidepressants work, focusing on the chemical balance being achieved in the brain and thus setting off a chain reaction into other areas of the body.

Blurred vision and weight gain are just two of several common side effects of antidepressants. Diabetes can be triggered by weight gain, even outside of a pregnancy. Gestational Diabetes can be triggered by excessive and uncontrolled weight gain in either the foetus or the mother. Some medications are coated with sugary outer layers, or encapsulated inside a glucose-based suspension. Alone, one pill or capsule may be ignored, but taken consistently, especially in conjunction with any other medications, twice a day, can spike blood sugar levels over time and result in the development of gestational Diabetes.

The placenta, itself, during the course of a pregnancy, can influence the blood sugar levels inside a woman’s body. This is one of several reasons that pregnancy check-ups involve testing of blood and/or urine samples.

Consider Diabetes when planning a family

If you haven’t already done so, it’s definitely worth visiting your doctor, nurse or clinic sister to talk about your family plans. If you haven’t undergone tests for Diabetes, getting started is simple so ask your medical practitioner about it. You can find out how likely you are to develop gestational Diabetes by knowing your current health status. This will help you plan and maintain a healthy pregnancy.

In all situations, you must remember that your body is unique. What your friends and family experience won’t be the exact same for you. Trust in your doctor, nurse or clinic sister, and get a second opinion if you need more reassurance. You have the right to know what’s going on with your body and health at all times. If planning for a family, you also have the responsibility to monitor your health along the way and speak to your medical team the moment you think something might be wrong.

Prioritise your own body and health because your baby depends on a healthy environment to grow and develop to full term. If you think you need antidepressants, or already using them, speak to your doctor/s about planning for a family. Check if you should be testing any different medicines before trying to conceive.

Sources:

Allen, A. 2011. Coping with side effects of depression treatment. WebMD. Article online. Available at: https://www.webmd.com/depression/features/coping-with-side-effects-of-depression-treatment#1 [Accessed 18 December 2019].

Howard, J. 2019. Antidepressants are linked to a higher gestational diabetes risk in a new study. CNN. Article online. 2 October. Available at: https://edition.cnn.com/2019/10/01/health/antidepressants-gestational-diabetes-pregnancy-study/index.html [Accessed 7 January 2020].

Marlow, A. 2017. I went off my depression meds to get pregnant, and this is what happened. Healthline. Article online. Available at: https://www.healthline.com/health/depression/pregnancy-depression-going-off-medication#1 [Accessed 18 December 2019].

Mayo Clinic. 2020. Gestational diabetes. Web page online. Available at: https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 [Accessed 7 January 2020].

OER Services. n.d. Maternal changes during pregnancy, labor, and birth. Anatomy and physiology II; Module 12: Development and inheritance. Course online. Available at: https://courses.lumenlearning.com/suny-ap2/chapter/maternal-changes-during-pregnancy-labor-and-birth/ [Accessed 7 January 2020].

Osborne, LM. 2020. Antidepressants and pregnancy: tips from an expert. Johns Hopkins Medicine. Web page online. Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/antidepressants-and-pregnancy-tips-from-an-expert [Accessed 7 January 2020].

Pagano, T. 2018. Pregnancy and antidepressants. WebMD. Article online. Available at: https://www.webmd.com/baby/pregnancy-and-antidepressants#1 [Accessed 7 January 2020].

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