A comprehensive synthesis of global evidence has revealed that gestational diabetes during pregnancy is associated with a decline in intellectual function among mothers and may elevate the risk of neurodevelopmental disorders, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), in children. This ongoing systematic review and meta-analysis, which encompasses 48 observational studies involving over 9 million pregnancies, was presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Vienna from September 15-19.
The findings highlight the growing prevalence of gestational diabetes in pregnancies, emphasizing the need for accurate management and early screening to mitigate neurocognitive complications for both mothers during pregnancy and children post-birth. “There are increasing concerns about the neurotoxic effects of gestational diabetes on the developing brain,” stated Assistant Professor Dr. Ling-Jun Li from the School of Medicine, National University of Singapore. “Our findings underscore the urgency of addressing this significant public health concern that poses substantial cognitive dysfunction risks for both mothers and offspring.”
Understanding Gestational Diabetes
Gestational diabetes, a form of diabetes that can develop during pregnancy, affects approximately 14% of pregnancies worldwide and is becoming more common. Those at greater risk include individuals living with obesity, those with a family history of diabetes, non-White mothers, and older mothers. Although gestational diabetes typically resolves after childbirth, it can lead to complications during and after pregnancy. Mothers face increased risks of high blood pressure and primary caesarean delivery, while their children are at higher risk of premature birth, large-for-gestational-age weight, and neonatal hypoglycemia. Furthermore, children are more likely to develop obesity and diabetes in adulthood.
Impact on Neurocognitive Development
While previous studies have indicated that gestational diabetes affects neurocognitive function in offspring, a comprehensive synthesis of available evidence was lacking until now. Researchers conducted a systematic review and meta-analysis, combining results from observational studies up to April 2024, to examine the impact of gestational diabetes on neurocognitive outcomes in both mothers antenatally and offspring (from birth to 29 years of age). The analysis involved 48 studies from 20 countries, encompassing over 9 million pregnancies globally.
The analysis of five studies on maternal antenatal cognitive function revealed that mothers with a history of gestational diabetes scored significantly lower—by an average of 2.47 points—on the Montreal Cognitive Assessment (total score out of 30) compared to those without the condition.
Children born to mothers with gestational diabetes had subsequent IQ scores 3.92 points lower than their counterparts, as well as a 3.18 point reduction in verbal crystallized intelligence.
Moreover, these children faced a 45% higher risk for total and partial developmental delays, were 36% more likely to have ADHD, and had a 56% increased risk for ASD.
Exploring the Mechanisms
Despite these findings, significant differences in major brain structure or general cognitive scores were not observed between children born to mothers with gestational diabetes and those without in the meta-analysis. The exact mechanisms by which gestational diabetes affects a child’s brain development remain unclear, though several hypotheses exist. Factors such as inflammation, cellular stress, reduced oxygen supply, and elevated insulin levels during pregnancy may influence brain development in the womb, potentially impacting learning and cognitive abilities as the child grows.
The research team emphasizes the need for further research to establish causality and clarify the associations between gestational diabetes and the full spectrum of cognitive functions. “Longer follow-ups across childhood are also needed to examine whether these associations persist or progress further to other worse outcomes,” noted Ms. Caitlin Por, a Medical Student at Monash University, Melbourne, Australia.
Implications and Future Directions
The implications of this research are profound, given the increasing incidence of gestational diabetes worldwide. The findings underscore the importance of early intervention and comprehensive management strategies to minimize potential neurocognitive risks. As the medical community continues to explore these associations, the focus will likely shift towards developing targeted prevention and treatment protocols to safeguard maternal and child health.
In conclusion, this study sheds light on the critical need for heightened awareness and proactive measures in addressing gestational diabetes. As more data becomes available, healthcare providers and policymakers must work collaboratively to implement effective strategies that can mitigate the long-term cognitive impacts associated with this condition.
