The association between gestational diabetes and fear of childbirth: a longitudinal register study

Gestational diabetes mellitus is a common condition known to be associated with pregnancy complications, larger fetus size and depression, and may therefore lead to increased concerns linked to childbirth. We sought to determine whether gestational diabetes mellitus is linked to fear of childbirth, and whether the possible association is mediated by depressive symptoms.

This study includes women who gave birth at the Kuopio University Hospital between 2019-2022 and had reported their level of fear of childbirth after gestational week 28 (n = 3293). Two outcome measures of fear of childbirth were used: self-rated intensity on a visual analogue scale, and obstetrician-confirmed diagnosis. Gestational diabetes mellitus was diagnosed based on plasma glucose concentrations in fasting state (≥ 5.3 mmol/l) and after a 75 g glucose load (one hour: ≥ 10.0 mmol/l, two hours: ≥ 8.6 mmol/l). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms in the third trimester. We performed logistic and linear regression analyses while adjusting for possible confounding factors and examined the controlled direct effect by including depressive symptoms in the model.

Gestational diabetes mellitus was associated with increased risk of fear of childbirth diagnosis (OR = 1.42, 95% CI 1.11─1.73) and higher levels of fear of childbirth (B = 0.31, 95% CI 0.09─0.53), but the associations were attenuated and no longer significant after further adjustments for body mass index and health behaviors (OR = 1.22, 95% CI 0.91─1.5; B = 0.11, 95% CI -0.13─0.35). Inclusion of depressive symptoms in the model attenuated the non-significant estimates further.

The observed association between fear of childbirth and gestational diabetes mellitus in previous studies may result from the lack of adjustments for confounding factors.