Independent and comorbid effects of antenatal depressive symptoms, gestational diabetes, and hypertensive disorders of pregnancy on early postpartum readmission — The Association Specialists
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  3. Independent and comorbid effects of antenatal depressive symptoms, gestational diabetes, and hypertensive disorders of pregnancy on early postpartum readmission

Independent and comorbid effects of antenatal depressive symptoms, gestational diabetes, and hypertensive disorders of pregnancy on early postpartum readmission (23486)

Biruk Abate 1 , Berihun Assefa Dachew 1 , Getinet Yaya Ayano 1 , Kim Betts 1 , Rosa Alati 1
  1. Curtin University, Queens Park, WA, Australia

Background: This study aims to examine the associations of antenatal depressive symptoms, alone and combined with HDP and/or GDM, with early postpartum readmissions.

Methods: We analysed population-based linked administrative health data from 149,025 mother–offspring pairs in Queensland, Australia. The cohort included women who gave birth between July 2015 and December 2021 with recorded EPDS. HDP and GDM were identified using ICD-10-AM codes. Logistic regression models estimated AORs for postpartum psychiatric and physical readmissions. Mediation analyses and interaction effects were assessed.

Results:  Antenatal depressive symptoms were independently associated with higher risks of postpartum psychiatric (AOR 3.07, 95% CI 2.81–3.36) and physical readmission (AOR 3.09, 2.85–3.35). HDP alone was not associated with either outcome, whereas GDM alone was modestly associated with psychiatric readmission (AOR 1.15, 1.03–1.28). Comorbid antenatal depressive symptoms with HDP or GDM were associated with markedly higher risks of both psychiatric and physical readmission compared with pregnancy complications alone. Depression with HDP was associated with increased odds of psychiatric (AOR 3.17, 2.49–4.04) and physical readmission (AOR 3.17, 2.56–3.91), while depression with GDM showed elevated risks of psychiatric (AOR 3.45, 2.92–4.07) and physical readmission (AOR 2.53, 2.18–2.95). Mediation analyses indicated that most associations were driven by direct effects, with neonatal outcomes explaining up to 9% of the total effect.

Conclusions: Antenatal depressive symptoms—particularly when co-occurring with gestational diabetes or hypertensive disorders of pregnancy—substantially increase the risk of early postpartum psychiatric and physical readmission beyond the independent effects of each condition. These relationships are primarily driven by direct pathways, with neonatal outcomes playing only a minor mediating role. The findings highlight the importance of integrated antenatal care that includes routine mental health screening, monitoring of pregnancy complications, and targeted postpartum follow-up to reduce preventable readmissions.