A comprehensive synthesis of global evidence reveals a concerning link between gestational diabetes and a decline in intellectual function among mothers, alongside an increased risk of neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This systematic review and meta-analysis, encompassing 48 observational studies and over 9 million pregnancies, is being presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Vienna, from September 15 to 19.
The findings highlight the growing prevalence of gestational diabetes and underscore the critical need for effective management and early screening to mitigate neurocognitive complications for both mothers during pregnancy and their children post-birth. “There are increasing concerns about the neurotoxic effects of gestational diabetes on the developing brain,” stated lead senior author 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 and Its Risks
Gestational diabetes, a type of diabetes that can develop during pregnancy, affects approximately 14% of pregnancies worldwide and is becoming increasingly common. Factors such as obesity, a family history of diabetes, and being an older or non-White mother elevate the risk. While gestational diabetes typically resolves after birth, it can lead to complications during and after pregnancy. Mothers face increased risks of high blood pressure and primary caesarean delivery, while their children may be born prematurely, with large-for-gestational-age weights, or experience neonatal hypoglycemia. Additionally, children are more likely to develop obesity and diabetes in adulthood.
Emerging evidence suggests that gestational diabetes also impacts neurocognitive function in offspring. However, until now, there has been no comprehensive synthesis of the available evidence.
Key Findings from the Meta-Analysis
In their systematic review and meta-analysis, researchers examined the impact of gestational diabetes on neurocognitive outcomes in mothers and their children, analyzing data from 48 studies involving over 9 million pregnancies across 20 countries. The analysis of five studies on maternal antenatal cognitive function revealed that mothers with a history of gestational diabetes scored an average of 2.47 points lower on the Montreal Cognitive Assessment, compared to those without the condition.
Further analyses of 43 studies on offspring cognitive function found significant disparities between children of mothers with gestational diabetes and their peers. For instance, children exposed to gestational diabetes had IQ scores 3.92 points lower and experienced a 3.18 point reduction in verbal crystallized intelligence. Additionally, these children faced a 45% higher risk for developmental delays, were 36% more likely to have ADHD, and had a 56% increased risk for ASD.
By the Numbers:
- 3.92 point reduction in IQ scores for children
- 45% higher risk for developmental delays
- 36% increased likelihood of ADHD
- 56% increased risk of ASD
However, the meta-analysis found no significant differences in major brain structure or general cognitive scores between children born to mothers with gestational diabetes and those who were not.
Exploring the Underlying Mechanisms
While the exact mechanisms by which gestational diabetes affects a child’s brain development remain unclear, several hypotheses exist. During pregnancy, factors such as inflammation, cellular stress, reduced oxygen supply, and elevated insulin levels may influence fetal brain development, potentially impacting learning and cognitive abilities as the child matures.
The research team emphasizes the need for further studies to establish causality and clarify the associations between gestational diabetes and 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 these findings are significant, given the increasing prevalence of gestational diabetes. They highlight the importance of proactive measures, including early screening and effective management of gestational diabetes, to safeguard the cognitive health of both mothers and their children. As research continues to unravel the complexities of this condition, healthcare providers and policymakers must prioritize interventions that address these neurocognitive risks.
Looking ahead, the ongoing research will be crucial in understanding the long-term cognitive outcomes associated with gestational diabetes and developing strategies to mitigate its impact. The insights gained from these studies could inform public health initiatives and clinical practices aimed at reducing the burden of gestational diabetes and its associated neurodevelopmental challenges.
