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A systematic review and meta-analysis published in The Lancet Diabetes & Endocrinology looks at associations between maternal diabetes and neurodevelopmental outcomes in children.
Prof Lucilla Poston, Professor of Maternal & Fetal Health, King’s College London said:
“The human fetus is exquisitely vulnerable to changes in its environment which may affect life-long health. In this extensive review, Ye et al have analysed data from 202 studies which investigated a potential effect of maternal diabetes on the fetal brain and mental health in childhood. A range of neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder (ADHD) were found to be strongly linked to pre-existing maternal Type 1 diabetes, Type 2 diabetes and also, but less so, to gestational diabetes (diabetes developing in pregnancy). This well conducted study followed strict rules for systematic review, and benefits from a focus on studies that ruled out several factors (confounders), such as maternal obesity or socioeconomic status which could explain the association. While the conclusion is that children born to mothers with diabetes are at risk of neurodevelopmental disorders, all contributing studies were observational, (with no attempt to intervene to prevent any effect), and ‘causality’ must be treated with caution. As appreciated by the authors, interpretation may be complicated by effects of diabetes treatment, and the international non-conformity in the diagnosis of gestational diabetes. However, other evidence does imply causality, including many studies in experimental animals. Also, data is emerging from MRI imaging of the brains of children exposed to maternal diabetes, showing structural and functional changes in the hypothalamus, a region of the brain intricately involved in both mental and physical health. For this and other reasons, diabetes prevention, screening and treatment remain critically important not only for the health of the mother, but also her child.”
Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies’ by Wenrui Ye et al. was published in The Lancet Diabetes & Endocrinology at 23:30 UK time on Monday 7th April.
Declared interests
Prof Lucilla Poston: “None commercial. I am funded by MRC to undertake a longitudinal population cohort (eLIXIR Born in South London) which has relevance to this project but no direct conflict.”