Exposure to Maternal Diabetes Increases Risk for ADHD in Offspring

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It is increasingly recognized that exposure to maternal diabetes during pregnancy may raise the risk for neurobehavioral disorders like ADHD in offspring.
It is increasingly recognized that exposure to maternal diabetes during pregnancy may raise the risk for neurobehavioral disorders like ADHD in offspring.

According to study results published in Diabetes Care, children exposed to maternal diabetes in utero are more likely to develop attention deficit hyperactivity disorder (ADHD) if their mother has a more severe case of diabetes.

To determine whether offspring are at greater risk for ADHD with increasing severity of maternal diabetes, researchers used electronic medical records to follow 333,182 children for a median of 4.9 years after age 4, the recommended age for diagnosis and treatment of ADHD.

Of the total population of children, 11.4% were exposed to diabetes in utero (522 to type 1 diabetes [T1D], 7822 to type 2 diabetes [T2D], and 29,534 to gestational diabetes) and 17,415 children were diagnosed with ADHD during the follow-up period. Overall, 9.2% of children exposed to T1D developed ADHD, compared with 6.2% exposed to T2D, 4.8% exposed to gestational diabetes, and 5.2% not exposed to maternal diabetes (P <.001 for between-group differences).

Although ADHD risk was not associated with exposure to gestational diabetes overall (P =.5) or with gestational age at diagnosis of gestational diabetes (P =.16), children exposed to gestational diabetes were significantly more likely to be diagnosed with ADHD if their mothers received antidiabetes medication compared with children whose mothers did not (P <.001).

Compared with children not exposed to diabetes during gestation, the adjusted hazard ratios for ADHD development were 1.57 for exposure to T1D, 1.43 for T2D, 1.26 for gestational diabetes requiring antidiabetes medication, and 0.93 for gestational diabetes not requiring medication.

Several limitations were reported for this study, including an absence of data on glycemia control during pregnancy.

“The three main types of diabetes during pregnancy were associated with offspring ADHD risk in a hierarchical order,” wrote the researchers, adding, “future studies are warranted to assess roles of glycemic control, potential causal factors and pathways, and approaches to mitigating ADHD risks.”

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Reference

Xiang AH, Wang X, Martinez MP, et al. Maternal gestational diabetes mellitus, type 1 diabetes, and type 2 diabetes during pregnancy and risk of ADHD in offspring [published online October 29, 2018]. Diabetes Care. doi:10.2337/dc18-0733

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