EMERGING evidence has suggested that maternal diabetes (MD) may influence child neurodevelopment, yet findings from individual studies have been mixed. To explore this relationship more robustly, researchers conducted a large-scale investigation into whether gestational diabetes mellitus (GD) or pre-existing diabetes in mothers is associated with neurodevelopmental, cognitive and behavioural outcomes in children. A recent study analysed data from over 200,000 mother-child pairs across ten birth cohorts in Europe and Australia, representing one of the largest investigations of its kind. Crucially, the findings indicated that children aged 4 to 10 years born to mothers with GDM were more likely to display attention-deficient hyperactive disorder (ADHD) symptoms and externalising behaviours.
To examine these associations, the researchers harmonised and pooled data from participating cohorts, selecting mother-child pairs with recorded GDM status and at least one relevant outcome assessed between the ages of 3 and 13. They employed two-stage individual participant data (IPD) meta-analysis using confounder-adjusted regression models. Adjustments in the full model accounted for child sex, maternal age, pre-pregnancy BMI, gestational weight gain, maternal smoking, plurality, parity and maternal education, in order to isolate the specific impact of maternal diabetes on child outcomes.
The results demonstrated a statistically significant association between GDM and increased ADHD symptoms in children aged 7–10 years, compared to non-exposed controls, with a regression coefficient (β) of 3.67 (95% CI 1.13–6.20; p=0.001). For children aged 4–6, GDM was linked with more externalising problems (β 2.77, 95% CI 0.52 to 5.02, P = 0.01). In analyses examining type 1 and type 2 diabetes before pregnancy, both were initially associated with higher ADHD symptoms at ages 4–6, but these associations did not persist after full adjustment for confounding variables.
This study supports an association between a dysregulated metabolic environment during pregnancy and neurodevelopmental outcomes in children, with clinical implications for the monitoring and management of GDM. However, limitations include reliance on harmonised data across cohorts, potential unmeasured confounding, and observational design which limits causal inference. Still, these findings underscore the importance of optimising maternal metabolic health prior to and during pregnancy, to support children’s long-term behavioural development.
Reference
Pretorius RA et al. Is maternal diabetes during pregnancy associated with neurodevelopmental, cognitive and behavioural outcomes in children? Insights from individual participant data meta-analysis in ten birth cohorts. BMC Pediatr. 2025;DOI: 10.1186/s12887-024-05365-y.
