Maternal Diabetes Increases Risk for Offspring Neurodevelopmental Disorders

Maternal diabetes increases risk for offspring neurodevelopmental disorders, according to results of a systematic review and meta-analysis published in The Lancet Diabetes and Endocrinology.

Maternal diabetes is increasingly prevalent, with gestational diabetes affecting up to 27.6% of pregnancies.

To evaluate the neurodevelopmental effects of maternal diabetes, investigators from Central South University in China searched publication databases through December 2024 for relevant cohort or case-control studies.

This analysis included a total of 202 articles with 56,082,462 mother-child pairs. Most studies were conducted in the American (38%), European (35%), and Western Pacific (19%) regions.

In the fully adjusted model, children of women with vs without maternal diabetes were at increased risk for any neurodevelopmental disorder (adjusted risk ratio [aRR], 1.28; 95% CI, 1.24-1.31; I², 81.8%). Stratified by type of diabetes, any neurodevelopmental disorder was associated with:

• Type 1 diabetes (aRR, 1.40; 95% CI, 1.31-1.50; I², 60.2%);
• Type 2 diabetes (aRR, 1.40; 95% CI, 1.34-1.46; I², 54.0%);
• Any pregestational diabetes (aRR, 1.39; 95% CI, 1.34-1.44; I², 57.7%);
• Unspecified pregestational diabetes (aRR, 1.35; 95% CI, 1.24-1.47; I², 55.3%);
• Unspecified diabetes (aRR, 1.20; 95% CI, 1.13-1.27; I², 65.9%); and,
• Gestational diabetes (aRR, 1.18; 95% CI, 1.14-1.23; I², 69.7%).

Stratified by individual neurodevelopmental outcome, maternal diabetes was associated with risks for:

• Intellectual disability (aRR, 1.32; 95% CI, 1.18-1.47; I², 91.3%);
• Attention-deficit/hyperactivity disorder (aRR, 1.30; 95% CI, 1.24-1.37; I², 88.9%);
• Specific developmental disorders (aRR, 1.27; 95% CI, 1.17-1.37; I², 82.9%);
• Autism spectrum disorder (aRR, 1.25; 95% CI, 1.20-1.31; I², 56.9%);
• Communication disorder (aRR, 1.20; 95% CI, 1.11-1.28; I², 52.8%);
• Motor disorder (aRR, 1.17; 95% CI, 1.10-1.26; I², 5.9%); and,
• Learning disorder (aRR, 1.16; 95% CI, 1.06-1.26; I², 55.5%).

Stratified by both neurodevelopmental and diabetes outcomes, trends were generally similar across specific neurodevelopmental disorders and diabetes types, except:

• Communication disorder was not associated with pregestational diabetes (aRR, 1.78; 95% CI, 0.80-3.97; I², 84.6%) or type 2 diabetes (aRR, 1.78; 95% CI, 0.80-3.97);
• Specific developmental disorders were not associated with type 1 diabetes (aRR, 1.22; 95% CI, 0.85-1.77; I², 84.6%);
• Intellectual disability was not associated with unspecified diabetes (aRR, 1.15; 95% CI, 0.94-1.42; I², 91.0%) or gestational diabetes (aRR, 1.13; 95% CI, 0.97-1.31; I², 82.5%); and,
• Motor disorder was not associated with unspecified pregestational diabetes (aRR, 1.10; 95% CI, 0.46-1.35) or unspecified diabetes (aRR, 1.05; 95% CI, 0.81-1.35; I², 0%).

The Egger’s test and contour-enhanced funnel plots suggested some publication bias, but trim-and-fill analyses were consistent with the main findings of this study.

The results of this analysis may not be generalizable, as most studies were conducted in high-income countries.

The study authors concluded, “[T]his systematic meta-analysis, comprising more than 56 million mother–child pairs, reveals significant implications of maternal diabetes on neurodevelopmental health in children. By highlighting these associations, we aim to raise awareness and encourage holistic actions from clinicians, policy-makers, and researchers, thereby improving health outcomes for both mothers and their children.”

This article originally appeared on Endocrinology Advisor