A comprehensive synthesis of global evidence reveals that gestational diabetes during pregnancy is associated with a decline in intellectual function among mothers and may elevate the risk of neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. These findings were presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Vienna, held from September 15-19.
The study, a systematic review and meta-analysis of 48 observational studies involving over 9 million pregnancies, emphasizes the growing prevalence of gestational diabetes and the critical need for accurate management and early screening. This approach could potentially mitigate neurocognitive complications for both mothers during pregnancy and their children after birth.
Understanding Gestational Diabetes
Gestational diabetes is a form of diabetes that can develop during pregnancy, affecting approximately 14% of pregnancies worldwide. It is increasingly common, particularly among those with obesity, a family history of diabetes, non-White mothers, and older mothers. Although gestational diabetes typically resolves after childbirth, it can lead to complications such as high blood pressure and primary caesarean delivery for mothers, and premature birth, large-for-gestational-age weight, and neonatal hypoglycemia for children.
Moreover, children born to mothers with gestational diabetes are at a higher risk of developing obesity and diabetes in adulthood. The study highlights the growing body of evidence indicating that gestational diabetes also affects neurocognitive function in offspring, although a comprehensive synthesis of this evidence had been lacking until now.
Research Findings and Implications
The research team conducted a systematic review and meta-analysis, analyzing data from studies up to April 2024, to examine the impact of gestational diabetes on neurocognitive outcomes in both mothers and offspring, ranging from birth to 29 years of age. The analysis included 48 studies from 20 countries worldwide.
“There are increasing concerns about the neurotoxic effects of gestational diabetes on the developing brain. Our findings underscore the urgency of addressing this significant public health concern that poses substantial cognitive dysfunction risks for both mothers and offspring,” explains lead senior author Assistant Professor Dr. Ling-Jun Li from the School of Medicine, National University of Singapore.
The analysis of five studies on maternal antenatal cognitive function revealed that mothers with a history of gestational diabetes scored significantly lower on the Montreal Cognitive Assessment compared to those without the condition. Additionally, 43 studies examining offspring cognitive function found significant disparities between children of pregnancies complicated by gestational diabetes and their peers. Children born to mothers with gestational diabetes had IQ scores 3.92 points lower and a 3.18 point reduction in verbal crystallized intelligence.
Children born to mothers who experienced gestational diabetes faced a 45% higher risk for total and partial developmental delays, were 36% more likely to have ADHD, and were at a 56% increased risk for 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 Mechanisms and Future Research
The exact mechanisms by which gestational diabetes affects a child’s brain development remain unclear. However, several potential explanations have been proposed. During pregnancy, factors such as inflammation, cellular stress, reduced oxygen supply, and high insulin levels may influence fetal brain development, potentially impacting learning and cognitive abilities as the child grows.
The research team emphasizes the need for further studies 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,” says the presenting author, Ms. Caitlin Por, a medical student at Monash University in Melbourne, Australia.
As the prevalence of gestational diabetes continues to rise, these findings highlight the importance of early intervention and targeted healthcare strategies to address the potential long-term cognitive and developmental risks associated with the condition. The research underscores the need for a concerted public health effort to better manage and mitigate the impacts of gestational diabetes on future generations.
