Gestational Diabetes Mellitus and Postpartum Depressive Symptoms in Women with Low and Late Fertility

<b>Background</b>: Dysregulation of the hypothalamic-pituitary-adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with "low and late" fertility, remains poorly characterized. <b>Methods</b>: We compared the risk of postpartum depressive symptoms, assessed on the second postpartum day using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score ≥ 12, and the Anhedonia, Anxiety, and Depression subscales, between Northeast Italian women with GDM and control participants with normal oral glucose tolerance tests (OGTT), classified as having "low and late fertility". <b>Results</b>: Among the 2560 women included in the analysis, 231 (9.02%) had GDM. Compared with controls with normal OGTT, women with GDM were older (36.0 vs. 33.0 years, <i>p</i> < 0.001) and had higher pre-pregnancy BMI (23.4 vs. 21.6 kg/m², <i>p</i> < 0.001), but lower gestational weight gain (GWG) (11.0 vs. 13.0 kg, <i>p</i> < 0.001), with no difference in parity [2.00 vs. 1.00, <i>p</i> = 0.5. In addition, GDM was not associated with increased postpartum depressive symptoms (15% EPDS scores ≥12 in both groups, <i>p</i> > 0.9) or with Anhedonia, Anxiety, or Depression subscale scores (<i>p</i> = 0.7). <b>Conclusions</b>: Advanced maternal age and reduced parity, hallmarks of women postponing childbearing, do not appear to confer an increased risk of early postpartum mood comorbidities in the context of GDM. Promoting healthy physical and mental well-being among women in this demographic category requires integrated strategies encompassing nutrition, healthcare, and education.