Diabetes in pregnancy ‘linked to neurodevelopmental disorder risk in children’

Having diabetes during pregnancy has been linked to an increased risk of neurodevelopmental disorders like autism and ADHD in children, a study suggests.

While academics stressed more research is needed, they said that “diligent monitoring” of blood sugar levels throughout pregnancy is “imperative”.

The meta-analysis conducted by Chinese researchers comprised 202 studies including more than 56 million pregnancies.

Of the total, 110 studies looked at gestational diabetes – which is developed during pregnancy and usually goes away after birth – while 80 looked at pre-gestational diabetes, when a woman has a type 1 or type 2 diabetes diagnosis before pregnancy.

The analysis found that the children of mothers with diabetes in pregnancy had a 28% increased risk of having any neurodevelopmental disorder compared to those whose mothers did not have the condition, even in studies which accounted for other factors that might explain the association.

When looking at individual disorders, researchers found there was a 25% increased risk of autism spectrum disorder (ASD), a 30% increased risk of attention-deficit/hyperactivity disorder (ADHD) and a 32% increased risk of intellectual disability.

Risks were higher in women who had diabetes before pregnancy compared to women who developed gestational diabetes.

Researchers said that the “diligent monitoring of maternal glycaemic concentrations throughout pregnancy is imperative”.

“To the best of our knowledge, this is the first comprehensive systematic review and meta-analysis to assess neurodevelopmental outcomes in children born to mothers with specific types of diabetes,” the team added.

They also warned that while the findings, published in The Lancet, “provide novel insights into the potential risks”, they should be “interpreted with caution”.

Responding to the study, Lucilla Poston, a professor of maternal and foetal health at King’s College London, said: “The human foetus is exquisitely vulnerable to changes in its environment which may affect life-long health.”

She added that the “well conducted” review “benefits from a focus on studies that ruled out several factors, such as maternal obesity or socioeconomic status which could explain the association”.

“While the conclusion is that children born to mothers with diabetes are at risk of neurodevelopmental disorders, all contributing studies were observational, with no attempt to intervene to prevent any effect, and causality must be treated with caution,” Prof Poston said.

“As appreciated by the authors, interpretation may be complicated by effects of diabetes treatment, and the international non-conformity in the diagnosis of gestational diabetes.

“However, other evidence does imply causality, including many studies in experimental animals.

“Also, data is emerging from MRI imaging of the brains of children exposed to maternal diabetes, showing structural and functional changes in the hypothalamus, a region of the brain intricately involved in both mental and physical health.

“For this and other reasons, diabetes prevention, screening and treatment remain critically important not only for the health of the mother, but also her child.”