Summary:
Gestational diabetes mellitus (GDM) occurs during pregnancy, with an estimated prevalence of up to 22.3% in Europe. GDM is associated with adverse outcomes for both the mother and baby, including complications during childbirth and long-term risks such as Type 2 Diabetes for the mother and metabolic syndrome in the baby. Emerging evidence also suggests a relationship between GDM and neurodevelopmental conditions in children. Several systematic reviews indicate an association between maternal diabetes and lower IQ, language impairments, as well as symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, many of these studies have had issues with quality and study design. The objective of this study was to conduct a systematic review and meta-analysis to assess the prevalence and risk of ADHD and ASD in children born to mothers with GDM. Given that hyperglycemia during pregnancy has been proposed as one potential pathophysiological mechanism for these disorders, understanding this connection may help identify early risk factors for their development, as ADHD and ASD can significantly impact quality of life. A comprehensive search was conducted across multiple databases, and two independent reviewers performed eligibility screening, risk of bias assessments, and data extraction. A total of 18 studies on ASD and 15 studies on ADHD were included. Meta-analysis revealed an increased risk of ASD when GDM was present but no significant increase in the risk for ADHD. The paper explores potential mechanisms underlying these differing risks, including diet and physical activity interventions in early pregnancy to reduce gestational weight gain and the risk of GDM. Socioeconomic status was also found to be an effect modifier in the association between GDM and neurodevelopmental disorders, indicating that broader determinants of health within healthcare should be considered to manage the risk of neurodevelopmental outcomes in children.
Abstract:
There is growing evidence for a role of maternal diabetes in the pathogenesis of neurodevelopmental disorders. However, the specific association between gestational diabetes (GDM), as opposed to pre-gestational diabetes, has been poorly isolated. Thus the aim was to systematically review and meta-analyse literature pertaining to prevalence and risk for two neurodevelopmental disorders: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), when exposed to GDM. PubMed, Cochrane Library, EMBASE, PsycINFO and CINAHL were systematically searched for eligible literature, with forward and backward citation tracking. Screening for eligibility, risk of bias assessment and data extraction were performed by two independent reviewers. 18 studies measuring ASD and 15 measuring ADHD met inclusion criteria. On meta-analysis there was an increased risk of ASD (OR 1.42; 95% CI 1.22, 1.65) but not ADHD (OR 1.01; 95% CI 0.79, 1.28). We discuss potential mechanisms for these differing risks. Greater understanding of risk factors, including GDM, for these neurodevelopmental disorders and potential mechanisms may help inform strategies aimed at prevention of exposure to these adversities during pregnancy.
Article Publication Date: 4/3/2021
DOI: 10.1038/s41598-021-84573-3
