Abstract
Background: Gestational diabetes mellitus (GDM) is a common condition defined as ‘glucose intolerance with onset during pregnancy’ and affects between 5% to 20% of women globally. The prevalence of GDM has been increasing for several years, following an upward trend in the population for obesity and type 2 diabetes. The psychological and medical burden of GDM is high and this includes medicalisation of the pregnancy, lifestyle changes and frequent attendance to joint diabetes and antenatal clinics. GDM is associated with neuropsychiatric morbidity in infants, poor obstetric outcomes and neurodevelopmental problems in infants, as well as increased risk of type 2 diabetes in both the mother and infant. Following a recent systematic review examining the distribution of mental disorders in the perinatal period in women with GDM, there is an increased risk of depressive symptoms within this group of women compared to those without GDM. Previous research highlights the impact of maternal mental health difficulties on attachment. However, to the author’s knowledge, no research exists which thoroughly assesses the mother-infant relationship in women with GDM. Therefore, a systematic review was conducted to examine the literature to assess the impact of other physical health problems in pregnant women on the mother-infant relationship. The following study aimed to test the hypothesis that GDM is associated with a perceived difficult mother-infant relationship in the first year of an infant’s life in a Scottish cohort of women recruited in pregnancy compared to mothers who do not have GDM, and whether the strength of this relationship is mediated by maternal mental health.Method: Peer-reviewed literature measuring physical health problems whilst pregnant and the mother-infant relationship were reviewed systematically. Quality was assessed using checklists where two independent reviewers were involved. Articles were synthesised using an integrative approach. Following the systematic review, a retrospective analysis of a Scottish cohort database (Growing Up in Scotland) was conducted with a dataset of 5289 women (N = 204 GDM, N = 5085 no GDM). Mediation analysis was utilised to examine whether there were significant differences in the mother-infant relationship for women with and without GDM, as well as if maternal mental health was a mediating factor for this relationship.
Results: Eight studies were included in the systematic review. Four studies demonstrated the positive impact of a physical health problem on the mother-infant relationship, two studies highlighted the negative impact of a physical health problem on the mother-infant relationship, and three studies appeared to demonstrate no impact. Following this, mediation analysis demonstrated that path a was not statistically significant which suggests that GDM does not predict maternal mental health. Path b was significant, which suggests that poor maternal mental health is significantly associated with a perceived difficult mother-infant relationship. The direct effect of GDM on the mother-infant relationship (path c) was not statistically significant. The indirect effect of GDM on the mother-infant relationship via maternal mental health (mediator) was also not significant.
Conclusion: This is the first robust study examining the impact of GDM on the mother-infant relationship. Although the current study did not support the hypotheses, the results are still of theoretical value to the research area, especially in the context of the extremely limited GDM and mother-infant relationship literature. The current study did find a significant relationship between maternal mental health and the mother-infant relationship which is in line with previous research. The implications for clinical practice are outlined alongside the areas for future research.
| Date of Award | 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Ash Summers (Supervisor), Susan Pawlby (Supervisor) & Khalida Ismail (Supervisor) |