Maternal diabetes link to ADHD in offspring

Aussie experts have weighed in on new research linking a type of diabetes with neurodevelopmental conditions such as ADHD and autism in offspring.

Maternal diabetes of all types has again been linked to neurodevelopmental conditions in children, including autism, ADHD, developmental delays, intellectual disability, cerebral palsy and epilepsy, new research has found.

And while Australian researchers say the Taiwanese study, published in the Developmental Medicine and Child Neurolology journal, is relevant for Aussie women, they have cautioned there is still much to be learned about the reasons behind the association.

Dr Filippe Oliveira, of the department of obstetrics and gynaecology at Monash University, said the link between maternal diabetes and neurodevelopmental delays in offspring was not new.

“This topic is relevant for Australians though, as the proportion of mothers with gestational diabetes has been increasing over the past few years (currently about 15 per cent) and we know that kids’ future health can be affected by high blood sugar in utero,” Dr Oliveira said. “So, we need more prospective studies in this area exploring how we can attenuate the short- and long-term effects on the offspring.”

Associate Professor Gino Pecoraro.

University of Queensland Associate Professor Gino Pecoraro and president of the National Association of Specialist Obstetricians and Gynaecologists (NASOG), said the study added to the body of knowledge about links between maternal diabetes and neurodevelopmental disorders.

“The study offers further support to the practice of looking for and diagnosing diabetes, of whichever type prior to and during pregnancy,” he said.

“It also points to the need for ongoing surveillance and research into the effects of diabetes can have.

“The mechanisms of harm causation from the different types of diabetes (type 1, type 2 and gestational) may be different but the take-home message is that diabetes is an important contributor to adverse events in both mothers and children. For this reason, it is important that it be looked for, and treated when found.”

The retrospective study looked at 877,233 children kids born between 2004 and 2008 whose mothers had type 1, type 2, or gestational diabetes during pregnancy.

The effect of type 1 diabetes on neurodevelopmental disorders was the largest, followed by type 2 diabetes, and then gestational diabetes.

Type 1 diabetes was associated with an increased risk of developmental delay, intellectual disability, and epilepsy in children.

Type 2 diabetes was associated with an increased risk of autism spectrum disorder, ADHD, developmental delay, intellectual disability, cerebral palsy, and epilepsy.

Gestational diabetes was associated with an increased risk of autism spectrum disorder, ADHD, and developmental delay.

“Mechanistic studies are needed to explore how maternal conditions, such as diabetes, may shape brain development in the womb,” said corresponding author Pao-Lin Kuo, MD, of National Cheng Kung University Hospital.

Professor Andrew Whitehouse.

Professor Andrew Whitehouse, Angela Wright Bennett Professor of Autism Research at the Telethon Kids Institute said that while the study was well-conducted, it’s findings did not “tell us a great deal about possible causal pathways to neurodevelopmental conditions, and should not prompt any clinical advice.”
“This is an epidemiological study that seeks to identify risk factors for neurodevelopmental disorders, such as autism and ADHD,” he said.

“So far, these studies have not contributed a great deal to our understanding of the causes of these conditions, other than to show that there is much we don’t know. This study is another in that tradition.

“While offspring of mothers with a disability had an increased chance of having a child diagnosed with a neurodevelopmental disorder, the increase was very small, and the association could have been caused by very many other things. This is very much a ‘correlation doesn’t equal causation’ story.”

Associate Professor Helen Leonard, principal research fellow at the Telethon Kids Institute, said while associations between maternal diabetes and birth defects in the offspring have been recognised for some time, relationships with neurodevelopmental outcomes are less well understood.

“The results of the study are significant because of the current growing epidemic of type 1 and type 2 diabetes which will affect more and more women of child-bearing age across the world, particularly those from under-resourced and disadvantaged populations,” she said. However, given its much higher prevalence it is fortunate that the risks for gestational diabetes were shown to be lower than for pregestational diabetes.”