Gestational diabetes in pregnancy raises risk of neurodevelopmental disorders, research suggests

Gestational diabetes in pregnant women could be linked to declining cognitive performance for mothers, while potentially increasing the risk of neurodevelopmental disorders in babies, including autism and attention-deficit/hyperactivity disorder (ADHD).

These are the preliminary findings from an ongoing systematic review and meta-analysis of 48 observational studies involving over nine million pregnancies.

The authors believe that given the increasing prevalence of gestational diabetes in pregnancies, their findings stress the importance of early screening of the condition.

This may be essential in reducing and detecting such neurocognitive complications for both mothers during pregnancy and children after birth.

“There are increasing concerns about the neurotoxic effects of gestational diabetes on the developing brain,” says lead senior author and 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.”

Importance of screening

Gestational diabetes is a metabolic disorder during pregnancy that poses significant risks to maternal and fetal health. The researchers highlight that it affects around 14% of pregnancies globally.

Over the last year, methods for screening the condition have improved, as in one recent paper that identified gut microbiome markers for its diagnosis. Tools to manage the condition have also improved, including AI smartphone photo meal scanning for instant personalized nutrition guidance.

But the condition is becoming more common, highlight the authors of the new review. This is evident among mothers who are living with obesity, have a family history of diabetes, are non-White, and are older.

Complications continue after birth

Gestational diabetes typically resolves after birth but it may cause complications after pregnancy, stress the study authors.

Children born of gestational diabetes are also more likely to develop obesity and diabetes in adulthood.For instance, mothers with the condition have an increased risk of high blood pressure and primary cesarean delivery. Their children are at higher risk of premature birth, being born with a large-for-gestational-age weight, and having neonatal hypoglycemia.

Children born of this condition are also more likely to develop obesity and diabetes in adulthood.

Until now, the researchers say there has been no “comprehensive synthesis” of the available evidence linking metabolic disorder that poses significant risks to maternal and fetal health.

To find out more, they conducted a systematic review and meta-analysis, combining the results of observational studies up to April 2024, examining the impact of gestational diabetes on neurocognitive outcomes in both mothers antenatally and offspring (from birth to 29 years of age).

They analyzed the data of 48 studies involving over nine million pregnancies from 20 countries. 

Their analysis of five studies on maternal antenatal cognitive function found 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.

Longer follow-ups are needed

Further analyses of 43 studies examining offspring cognitive function also found statistically significant disparities between children of pregnancies complicated by gestational diabetes and their counterparts.

For example, children born to mothers with gestational diabetes had subsequent IQ scores 3.92 points lower than children not exposed to the condition, as well as a 3.18 point reduction in verbal crystallized intelligence — the ability to understand, analyze, and communicate effectively through language.

Additionally, 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 autism.

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.

The authors say that it is still not fully clear how gestational diabetes affects a child’s brain development. However, they suggest several possible explanations.

During pregnancy, factors such as inflammation, stress in the body’s cells, reduced oxygen supply, and high insulin levels may influence how the baby’s brain develops in the womb. This may later affect learning and cognitive abilities as the child grows, suggest the researchers.

However, the scientists say that more research is needed to establish causality and clarify the links 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 co-author, Caitlin Por, a Medical Student at Monash University, Melbourne, Australia.

The researchers are presenting their findings at this week’s Annual Meeting of The European Association for the Study of Diabetes, in Vienna, Austria (September 15–19).