{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T05:00:15Z","timestamp":1785474015352,"version":"3.56.0"},"reference-count":51,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012957","name":"Friedrich Schiller-University Jena","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012957","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05qpz1x62","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Depressive symptoms are more frequent following pregnancies complicated by gestational diabetes mellitus (GDM), prompting postpartum depression screening recommendations in the German S3 guideline. Although GDM is associated with increased postpartum depression risk, the relationships between postpartum metabolic parameters and the Edinburgh Postnatal Depression Scale (EPDS) scores remain unclear. We investigated whether metabolic markers measured during diabetes screening 6\u201312 weeks postpartum are associated with depressive symptoms. Methods: We retrospectively analyzed EPDS screenings conducted during postpartum testing at our inpatient clinic between 07\/2021 and 02\/2024. The EPDS is a validated 10-item tool (score range 0\u201330), with scores \u226510 indicating potential depression. Metabolic parameters included HbA1c, the 75 g oral glucose tolerance test (oGTT), insulin, and the Homeostasis Model Assessment index (HOMA index). Group comparisons were performed using non-parametric tests and receiver operating characteristic (ROC) analyses, with the Youden index identifying optimal cutoffs. Results: Among the 102 women presenting for postpartum testing, 43.1% had normal glucose tolerance, 54.9% prediabetes, and 2.0% diabetes. A total of 13.7% (n = 14) screened positive for potential depression, including two who reported suicidal ideations. Women with positive EPDS scores had significantly higher HbA1c [5.7% (38.3 mmol\/mol) vs. 5.4% (35.5 mmol\/mol), p = 0.013]. An HbA1c cutoff of 5.42% (35.75 mmol\/mol) showed discriminatory ability for depressive symptoms with an Area Under the Curve (AUC) of 0.708 (CI 0.567\u20130.849). Other metabolic parameters showed no significant associations. Conclusions: Elevated postpartum HbA1c is associated with depressive symptoms after GDM pregnancies. An HbA1c threshold of 5.42% (35.75 mmol\/mol) may help identify women at increased postpartum depression risk and prompt subsequent psychological assessment when depression screening is otherwise omitted.<\/jats:p>","DOI":"10.3390\/jcm15155919","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:13:47Z","timestamp":1785320027000},"page":"5919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between HbA1c Levels and Postpartum Depressive Symptoms: Insights from Edinburgh Postnatal Depression Scale Screening After Gestational Diabetes Mellitus"],"prefix":"10.3390","volume":"15","author":[{"given":"Sophia","family":"Lutz","sequence":"first","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7591-2045","authenticated-orcid":false,"given":"Yvonne","family":"Lindemann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard","family":"Schleu\u00dfner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3553-4056","authenticated-orcid":false,"given":"Tanja","family":"Groten","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Stra\u00dfe 34, 50931 K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-391X","authenticated-orcid":false,"given":"Friederike","family":"Weschenfelder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Fischer, S., and Morales-Su\u00e1rez-Varela, M. (2023). The Bidirectional Relationship between Gestational Diabetes and Depression in Pregnant Women: A Systematic Search and Review. Healthcare, 11.","DOI":"10.3390\/healthcare11030404"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1146\/annurev-med-041217-011106","article-title":"Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics","volume":"70","author":"Stewart","year":"2019","journal-title":"Annu. Rev. Med."},{"key":"ref_3","first-page":"e64219","article-title":"The Relationship Between Gestational Diabetes and Postpartum Depression: A Systematic Review","volume":"16","author":"Alasmre","year":"2024","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hahn-Holbrook, J., Cornwell-Hinrichs, T., and Anaya, I. (2017). Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front. Psychiatry, 8.","DOI":"10.3389\/fpsyt.2017.00248"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"112922","DOI":"10.1016\/j.diabres.2025.112922","article-title":"Association between gestational diabetes mellitus and postpartum depression: An updated systematic review and meta-analysis","volume":"229","author":"Nourollahi","year":"2025","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.diabres.2019.01.034","article-title":"The association between gestational diabetes and postpartum depression: A systematic review and meta-analysis","volume":"149","author":"Azami","year":"2019","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Song, X., Zheng, Q., Zhang, R., Wang, M., Deng, W., Wang, Q., Guo, W., Li, T., and Ma, X. (2021). Potential Biomarkers for Predicting Depression in Diabetes Mellitus. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.731220"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1055\/a-0659-2596","article-title":"Gestational Diabetes Mellitus (GDM)\u2014Diagnosis, Treatment and Follow-Up. Guideline of the DDG and DGGG (S3 Level, AWMF Registry Number 057\/008, February 2018)","volume":"78","author":"Gembruch","year":"2018","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1055\/a-2500-0411","article-title":"Gestational Diabetes Mellitus (GDM), Diagnostics, Therapy and Follow-up Care","volume":"133","author":"Laubner","year":"2025","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_10","unstructured":"GestDiab (2025, October 03). Gestdiab 2023: Auswertung f\u00fcr Gestationsdiabetes. Available online: https:\/\/www.windiab.de\/wp-content\/uploads\/2025\/05\/GestDiab-fuer-Feedback-2023-mit-Daten-2008-2023-website-GDM.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"676","DOI":"10.2337\/dc10-0719","article-title":"International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy","volume":"33","author":"Metzger","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"World Health Organization (2014). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline. Diabetes Res. Clin. Pract., 103, 341\u2013363.","DOI":"10.1016\/j.diabres.2013.10.012"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Juan, J., Sun, Y., Wei, Y., Wang, S., Song, G., Yan, J., Zhou, P., and Yang, H. (2022). Progression to type 2 diabetes mellitus after gestational diabetes mellitus diagnosed by IADPSG criteria: Systematic review and meta-analysis. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1012244"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zaccara, T.A., Paganoti, C.F., Mikami, F.C.F., Francisco, R.P.V., and Costa, R.A. (2022). WHO criteria for diabetes in pregnancy: A retrospective cohort. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04708-w"},{"key":"ref_15","first-page":"e79334","article-title":"Management of Diabetes in Pregnancy: A Review of Clinical Guidelines and Practices","volume":"17","author":"Albairmani","year":"2025","journal-title":"Cureus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1055\/a-1789-5615","article-title":"Definition, Klassifikation, Diagnostik und Differenzialdiagnostik des Diabetes mellitus: Update 2022","volume":"17","author":"Landgraf","year":"2022","journal-title":"Diabetol. Stoffwechs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/eurjcn\/zvab104","article-title":"Research Electronic Data Capture (REDCap): Tackling data collection, management, storage, and privacy challenges","volume":"21","author":"Wampers","year":"2022","journal-title":"Eur. J. Cardiovasc. Nurs."},{"key":"ref_20","unstructured":"Roche Diagnostics International AG (2026, June 28). Tina-Quant Hemoglobin A1cDx Gen. 3 Assay (Cobas c 513), Instructions for Use. Available online: https:\/\/elabdoc-prod.roche.com\/eLD\/api\/downloads\/2d4674e1-c635-e711-669c-00215a9b3428?countryIsoCode=us."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s40292-022-00542-5","article-title":"HOMA-IR as a predictor of Health Outcomes in Patients with Metabolic Risk Factors: A Systematic Review and Meta-analysis","volume":"29","author":"Solis","year":"2022","journal-title":"High Blood Press. Cardiovasc. Prev."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Khalili, D., Khayamzadeh, M., Kohansal, K., Ahanchi, N.S., Hasheminia, M., Hadaegh, F., Tohidi, M., Azizi, F., and Habibi-Moeini, A.S. (2023). Are HOMA-IR and HOMA-B good predictors for diabetes and pre-diabetes subtypes?. BMC Endocr. Disord., 23.","DOI":"10.1186\/s12902-023-01291-9"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale","volume":"150","author":"Cox","year":"1987","journal-title":"Br. J. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1007\/s00404-022-06525-0","article-title":"Predictive validity of the Edinburgh postnatal depression scale and other tools for screening depression in pregnant and postpartum women: A systematic review and meta-analysis","volume":"307","author":"Park","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1055\/s-2007-1023895","article-title":"Deutschsprachige Fassung und Validierung der \u201cEdinburgh postnatal depression scale\u201d","volume":"123","author":"Bergant","year":"1998","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"m4022","DOI":"10.1136\/bmj.m4022","article-title":"Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: Systematic review and meta-analysis of individual participant data","volume":"371","author":"Levis","year":"2020","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/aogs.14734","article-title":"Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy","volume":"103","author":"Rondung","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"195","DOI":"10.4103\/tjem.tjem_182_23","article-title":"Receiver operating characteristic curve analysis in diagnostic accuracy studies: A guide to interpreting the area under the curve value","volume":"23","author":"Aksel","year":"2023","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1111\/cyt.13208","article-title":"Recommendations for reporting measures of diagnostic accuracy","volume":"34","author":"Vrbin","year":"2023","journal-title":"Cytopathology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E","article-title":"Two-sided confidence intervals for the single proportion: Comparison of seven methods","volume":"17","author":"Newcombe","year":"1998","journal-title":"Stat. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1080\/01621459.1927.10502953","article-title":"Probable Inference, the Law of Succession, and Statistical Inference","volume":"22","author":"Wilson","year":"1927","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S2213-8587(24)00234-1","article-title":"Depression symptoms, wellbeing, health-related quality of life, and diabetes-related distress in novel subtypes of recent-onset diabetes in Germany: A 5-year observational follow-up study","volume":"12","author":"Sommer","year":"2024","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1007\/s00125-025-06369-8","article-title":"Differential associations of somatic and cognitive-affective symptoms of depression with inflammation and insulin resistance: Cross-sectional and longitudinal results from the Emotional Distress Sub-Study of the GRADE study","volume":"68","author":"Ehrmann","year":"2025","journal-title":"Diabetologia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101107","DOI":"10.1016\/j.molmet.2020.101107","article-title":"Review: Glucose-sensitive insulin","volume":"46","year":"2021","journal-title":"Mol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Hariri, A., Mirian, M., Zarrabi, A., Kohandel, M., Amini-Pozveh, M., Aref, A.R., Tabatabaee, A., Prabhakar, P.K., and Sivakumar, P.M. (2023). The circadian rhythm: An influential soundtrack in the diabetes story. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1156757"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ambalavanan, J. (2025). Updated Review of HOMA-IR (Homeostatic Model Assessment for Insulin Resistance). Evid. Action Off. J. MDCalc, 042025.","DOI":"10.65357\/001c.154184"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1111\/jdi.12969","article-title":"Longitudinal investigation of the reciprocal relationship between depressive symptoms and glycemic control: The moderation effects of sex and perceived support","volume":"10","author":"Chiu","year":"2019","journal-title":"J. Diabetes Investig."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"112014","DOI":"10.1016\/j.diabres.2025.112014","article-title":"The role of depression and diabetes distress in glycemic control: A meta-analysis","volume":"221","year":"2025","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00592-019-01295-9","article-title":"The prevalence of comorbid depression in patients with type 2 diabetes: An updated systematic review and meta-analysis on huge number of observational studies","volume":"56","author":"Khaledi","year":"2019","journal-title":"Acta Diabetol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.52225\/narra.v2i1.51","article-title":"Association between depression and HbA1c levels in the elderly population with type 2 diabetes mellitus during COVID-19 pandemic","volume":"2","author":"Zahra","year":"2022","journal-title":"Narra J."},{"key":"ref_43","first-page":"e22688","article-title":"The Association of Hemoglobin A1c Levels and Depression Among Adults With Diabetes in the United States","volume":"14","author":"Langberg","year":"2022","journal-title":"Cureus"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1017\/S1463423617000317","article-title":"Association between gestational diabetes and perinatal depressive symptoms: Evidence from a Greek cohort study","volume":"18","author":"Varela","year":"2017","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1111\/j.1471-0528.2010.02660.x","article-title":"Perinatal complications increase the risk of postpartum depression. The Generation R Study","volume":"117","author":"Blom","year":"2010","journal-title":"BJOG"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.jclinepi.2022.09.009","article-title":"Logistic regression frequently outperformed propensity score methods, especially for large datasets: A simulation study","volume":"152","author":"Wilkinson","year":"2022","journal-title":"J. Clin. Epidemiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"265","DOI":"10.2188\/jea.JE20210089","article-title":"Bias in Odds Ratios From Logistic Regression Methods With Sparse Data Sets","volume":"33","author":"Gosho","year":"2023","journal-title":"J. Epidemiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1097\/01.ede.0000135174.63482.43","article-title":"A structural approach to selection bias","volume":"15","author":"Robins","year":"2004","journal-title":"Epidemiology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/EDE.0000000000001711","article-title":"Differential Participation, a Potential Cause of Spurious Associations in Observational Cohorts in Environmental Epidemiology","volume":"35","author":"Chen","year":"2024","journal-title":"Epidemiology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e1873","DOI":"10.1002\/mpr.1873","article-title":"Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta-analysis","volume":"30","author":"Neupane","year":"2021","journal-title":"Int. J. Methods Psychiatr. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5919\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:36:25Z","timestamp":1785472585000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":51,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155919"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155919","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}