Is gestational diabetes associated with adverse maternal and child mental health outcomes?

妊娠期糖尿病（GDM）是指妊娠期间发生的糖尿病（即血液中血糖水平过高）。在英国，大约每20个孕妇中就有一个受到影响。怀孕期间的精神疾病更为普遍，是影响围产期（怀孕期间或分娩后一年）妇女的最常见疾病，在英国约有五分之一的妇女受到影响。虽然众所周知，在普通人群中，糖尿病患者患抑郁症的几率是非糖尿病患者的两倍，但人们对精神疾病和GDM之间的联系知之甚少，包括GDM患者患精神疾病的几率。关于GDM和围产期精神疾病之间关系的潜在原因，我们所知的就更少了。GDM和围产期精神疾病都与儿童可能出现的情绪问题和学习迟缓有关。然而，同时患有精神疾病和GDM对儿童的影响从未被研究过。然而，GDM和精神疾病都是可以预防的。在提议的奖学金期间，我将：1)调查GDM增加围产期精神疾病风险的程度。2)调查GDM母亲在怀孕期间是否有精神疾病更容易在未来发展为糖尿病。3)比较妊娠期母亲患有GDM并有精神疾病与母亲患有GDM但无精神疾病的儿童的发育情况。如果找到了联系，就会探究其中的原因。在我的第一个研究中，我将系统地回顾现有的相关研究文献，评估其质量，以告知我自己的研究方法。在这篇综述中，我的目的是计算患有GDM的妇女在怀孕期间和分娩后一年内精神疾病的常见程度，以确定患有GDM的妇女患精神疾病的风险程度。我还将探讨为什么会这样的潜在原因。在我的第二项研究中，我将使用从布拉德福德的一组母亲和她们的孩子（称为出生在布拉德福德：BiB研究）收集的信息来回答我的每一个研究问题。所有参与研究的母亲都接受了GDM测试。这将提供哪些母亲患有GDM的信息（从9779名女性中总共有681例GDM），然后我可以检查这些女性比没有GDM的女性更容易患精神疾病的程度。在诊断为GDM的母亲中，迄今为止的糖尿病诊断也可从初级保健记录中获得。这将意味着我可以检查患有GDM和精神疾病的女性是否比患有GDM和没有疾病的女性更容易在出生后患糖尿病。然后，我将使用由孩子的老师完成的两份评估来检查母亲的GDM和精神疾病对孩子的影响。一份是他们四岁时的情感发展（来自标准问卷），另一份是他们七岁时的学校表现，来自国家评估。在探索我发现的重要联系的潜在原因时，我将使用来自母亲生活方式的研究信息，如饮食和身体活动水平以及新生儿和母亲的血液测试。这项研究将为GDM和精神疾病之间的联系提供知识和更好的理解。如果GDM患者的精神疾病影响未来糖尿病的发展和孩子的发展，那么这项研究应该有助于科学家制定策略，不仅改善母亲的长期健康，也改善她的孩子的健康。

Gestational diabetes mellitus (GDM) is diabetes (i.e. sugar levels being too high in the blood) arising during pregnancy. Around one in 20 pregnant women are affected in the UK. Mental illness during pregnancy is even more prevalent and is the most common illness to affect women during the perinatal period (during pregnancy or one year following delivery), with around one in five affected in the UK. While it is known that depression is twice as common in the general population amongst those who have diabetes, as those who do not, less is known about the link between mental illness and GDM, including how common mental illness is in those with GDM. Even less is known about potential reasons for a relationship between GDM and mental illness in the perinatal period. Both GDM and perinatal mental illness have been linked to possible emotional problems and learning delays in the child. However the effect of having both mental illness and GDM on the child has never been studied. Yet both GDM and mental illnesses are preventable conditions. During the proposed fellowship I will:1) Investigate the extent to which GDM increases the risk of perinatal mental illness.2) Investigate whether or not mothers with GDM who also have mental illness during pregnancy are more likely to go on to develop diabetes in the future.3) Compare the development of children whose mothers had GDM and mental illness during pregnancy to those whose mothers had GDM but no mental illness. If links are found, reasons for these will be explored.In my first study, I will systematically review the existing relevant research literature, assessing its quality, to inform my own research methods. During this review, I will aim to calculate how common mental illnesses are during pregnancy and in the year following delivery for women with GDM in order to ascertain the extent of the risk for mental illness in women have GDM. I will also explore potential reasons why this might be.In my second study, I will use information collected from a group of mothers and their children in Bradford (called the Born in Bradford: BiB study) to answer each of my research questions. All mothers in the study were offered a test for GDM. This will provide information on which mothers had GDM (681 cases of GDM from 9779 women in total) then I can examine to what extent these women are more likely to have mental illnesses than women without GDM. Diagnoses of diabetes up to the present day in mothers following their diagnosis of GDM will also be available from primary care records. This will mean I can examine whether women with GDM and mental illness are more likely to develop diabetes after birth compared with women with GDM and no illness. I will then use two assessments completed by the child's teacher to examine the effects of GDM and mental illness in the mother on the child. One is of their emotional development (from a standard questionnaire) at the age of four years and the other is of their performance at school from national assessments at the age of seven years. In exploring potential reasons for significant links that I find, I will use information from the study about the mother's lifestyle such as diet and physical activity levels and blood tests from the newborn and mother.This research will provide knowledge and a better understanding of the link between GDM and mental illness. If it appears that mental illness in those with GDM influences the development of diabetes in the future and the development of the child then this research should help scientists to develop strategies for improving the long-term health of not only the mother but also her child.