ADHD and Autism Spectrum Disorder Linked to Diabetes Exposure in Utero

Exposure to diabetes in utero increases the risks for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and adverse cardiometabolic outcomes among children, according to findings from a population-based cohort study published in Diabetes Care.

The rate of gestational diabetes more than doubled between 2005 and 2018 in Alberta, Canada. Although previous research findings support a link between the incidence of gestational diabetes and risk for short-term pregnancy and offspring outcomes, little evidence supports the long-term outcomes of gestational diabetes among offspring.

Researchers sourced data from regional registers in Ontario, Canada to assess the link between in utero exposure to diabetes and the risk of developing adverse neurodevelopmental and metabolic outcomes. Live births that occurred between 1991 to 2018 were included in this analysis and offspring were followed through 2020 or outcomes.

Risk for ADHD, ASD, and cardiometabolic outcomes were evaluated among birth parent-offspring pairs (N=3,407,961) on the basis of preexisting type 1 diabetes or type 2 diabetes (n=48,839), gestational diabetes (n=172,817), and no diabetes during pregnancy (n=3,186,305).

Among the preexisting diabetes (mean age, 32.37 years), gestational diabetes (mean age, 32.00 years), and control (mean age, 19.57 years) cohorts, 35.8%, 46.1%, and 48.0% of participants were nulliparous; 51.3%, 52.0%, and 51.2% of babies were boys; and 26.4%, 26.5%, and 22.4% of pairs were in the lowest income quintile, respectively.

During a median 13.63-year follow-up, the cumulative incidence rates of ADHD, ASD, diabetes, hypertension, and cardiovascular disease (CVD) differed significantly between subgroups and were highest for offspring of birth parents with type 1 diabetes (all P <.0001).

Compared with offspring who were unexposed to diabetes in utero, risk for ADHD was associated with exposure to:

• Type 1 diabetes (adjusted hazard ratio [aHR], 1.43);
• Type 2 diabetes (aHR, 1.25); and,
• Gestational diabetes (aHR, 1.03).

Risk for ASD was associated with exposure to:

• Type 1 diabetes (aHR, 1.94);
• Type 2 diabetes (aHR, 1.64); and,
• Gestational diabetes (aHR, 1.40).

Risk for diabetes was associated with exposure to:

• Type 1 diabetes (aHR, 4.73);
• Type 2 diabetes (aHR, 3.31); and,
• Gestational diabetes (aHR, 1.73).

Risk for hypertension was associated with exposure to:

• Type 1 diabetes (aHR, 2.32);
• Type 2 diabetes (aHR, 1.71); and,
• Gestational diabetes (aHR, 1.35).

Risk for CVD was associated with exposure to type 1 (aHR, 1.72) and type 2 (aHR, 1.24) diabetes.

Increasing glycated hemoglobin (HbA_1C) levels during pregnancy were associated with increased risks for diabetes (aHR, 1.22; P =.0003), hypertension (aHR, 1.31; P <.0001), and CVD (aHR, 1.25; P <.0001) among offspring. However, the outcomes of ADHD and ASD were not related with HbA_1C levels.

Study limitations include missing HbA_1C data among some participants and the absence of adjustments for birth parental BMI.

The researchers concluded, “[C]hildren of women with diabetes are at increased risk of neurobehavioral and cardiometabolic outcomes, including ADHD, ASD, hypertension, diabetes, and CVD, with a gradient of risk seen depending on diabetes type. Maternal glycemia in women with preexisting diabetes is clearly associated with an increased risk of these long-term cardiometabolic outcomes in offspring, but this association is not clear with regards to the neurobehavioral outcomes.”

Disclosure: This research was supported by Sun Life Canada. B.R.S. Please see the original reference for a full list of disclosures.

This article originally appeared on Endocrinology Advisor