Influence of Maternal Diabetes on the Risk of Neurodevelopmental Disorders in Offspring in the Prenatal and Postnatal Periods

Background: This study aimed to evaluate the influence of maternal diabetes in the risk of neurodevelopmental disorders in off-spring in the prenatal and postnatal periods.Methods: This cohort study included singleton gestational diabetes mellitus (GDM) pregnancies >22 weeks' gestation with live newborns between 1991 and 2008. The control group was randomly selected and matched (1:2) for maternal age, weeks of gesta-tion and birth year. Cox regression models estimated the effect of GDM on the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and maternal type 2 diabetes mellitus (T2DM). Moreover, interaction between ma-ternal T2DM and GDM-ADHD relationship was evaluated.Results: Children (n= 3,123) were included (1,073 GDM; 2,050 control group). The median follow-up was 18.2 years (interquar-tile range, 14.2 to 22.3) (n= 323 with ADHD, n= 36 with ASD, and n= 275 from women who developed T2DM). GDM exposure was associated with ADHD (hazard ratio [HR]crude, 1.67; 95% confidence interval [CI], 1.33 to 2.07) (HRadjusted, 1.64; 95% CI, 1.31 to 2.05). This association remained significant regardless of the treatment (diet or insulin) and diagnosis after 26 weeks of gesta-tion. Children of mothers who developed T2DM presented higher rates of ADHD (14.2 vs. 10%, P= 0.029). However, no interac-tion was found when T2DM was included in the GDM and ADHD models (P> 0.05). GDM was not associated with an increased risk of ASD (HRadjusted, 1.46; 95% CI, 0.74 to 2.84).Conclusion: Prenatal exposure to GDM increases the risk of ADHD in offspring, regardless of GDM treatment complexity. How-ever, postnatal exposure to maternal T2DM was not related to the development of ADHD.