Children are at far greater risk of developing attention deficit hyperactivity disorder (ADHD) or being on the autism spectrum if they are born to mothers who had gestational diabetes mellitus (GDM), an analysis of over nine million pregnancies reveals.
The study, presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Vienna, suggests this pregnancy complication may have neurotoxic effects on brain development.
The systematic review and meta-analysis of observational studies and clinical trials showed that children whose mothers had gestational diabetes had a 36% increased risk of ADHD and a 56% increased risk of autism spectrum disorder (ASD) compared with those whose mothers who did not experience GDM.
“In terms of personalized medicine, our findings underscore the neurocognitive risks of GDM and the need for timely screening and intervention,” Professor Ling-Jun Li, PhD, from the National University of Singapore, told Inside Precision Medicine.
“During pregnancy, this means close monitoring and control of blood glucose. After birth, ongoing developmental screening can aid in early detection and management of neurocognitive challenges in children exposed to GDM.”
Gestational diabetes affects around 14% of pregnancies worldwide and is particularly common in women who are obese and those who have a family history of diabetes, are not White, and are older.
While the condition usually disappears after birth, it can result in an increased likelihood of high blood pressure during their pregnancy and cesarean deliveries.
Children born to mothers with GDM are also at increased risk of premature birth, being born heavy for their age, or having neonatal hypoglycemia. Previous studies have also suggested they are at increased risk of diabetes or obesity as adults.
To investigate the impact of this pregnancy complication further, the researchers examined data from 48 studies conducted in more than 20 countries—mainly in Asia, the U.S., and Europe.
Five studies indicated that mothers with GDM had significantly lower cognitive function before pregnancy, with a Montreal Cognitive Assessment score that was 2.47 points lower out of a maximum possible of 30 compared with women who did not have GDM.
Among 43 studies of cognitive function in babies, children born to women with gestational diabetes had an IQ that was 3.92 points lower than other children, and a 3.18-point lower score in verbal crystallized intelligence, which reflects the ability to understand, analyze, and communicate effectively through language.
Children from pregnancies complicated by gestational diabetes also had a higher risk of total and partial developmental delays (odds ratio=1.45), together with substantially increased ADHD and ASD (odds ratios=1.36 and 1.56, respectively).
However, there were no significant differences between the children in major brain structure or general cognitive scores.
The researchers conclude that pregnancies complicated by GDM are associated with neuro-cognitive decline in both mothers and their offspring, as indicated by a decline in intellectual function and increase in disorders among the children, as assessed using neurocognitive screening tools.
They maintain that further research on cognitive function relating to GDM is essential for postpartum follow-up, particularly given the increasing prevalence of GDM in pregnancies.
