Emerging data suggest that the offspring of mothers who have diabetes during pregnancy are at increased risk of cognitive and neurodevelopmental disorders. These mental effects are in addition to better-known metabolic risks associated with maternal diabetes.

“We have been studying the metabolic effects of high blood sugar in the mom for two decades, fundamental causes of the high blood sugar, complications at birth, and beyond,” said Anny Xiang, PhD, Senior Research Scientist and Director of Biostatistics Research at Kaiser Permanente Southern California. “Epidemiological studies have demonstrated that when moms have diabetes during pregnancy, the children also have increased risk of diabetes and obesity, a metabolic effect from one generation to the next. Now we are finding mental health effects.”

Dr. Xiang will explore the growing epidemiological association between maternal diabetes and autism and attention-deficit/hyperactivity disorder (ADHD) in children during Sunday’s symposium Maternal Effects on Offspring Cognitive and Neurodevelopment, which will begin at 4:30 p.m. in S-157 (South, Upper Mezzanine Level). The session’s presenters will discuss the latest findings about mental function in children whose mothers had diabetes during pregnancy.

“We know that these children have a higher risk of developing diabetes themselves,” said Peter Damm, MD, DMSc, Professor of Obstetrics and Head of the Center for Pregnant Women With Diabetes at the Rigshopitalet, University of Copenhagen, Denmark. “Now, our studies have found that children of mothers with type 1 diabetes have a little lower IQ score when they are tested after puberty. The effect in gestational diabetes and type 2 diabetes is more debatable.”

The increased risk for autism and ADHD associated with maternal diabetes is not the same for type 1, type 2, and gestational diabetes diagnosed during pregnancy, Dr. Xiang said. Elevated glucose levels in utero may play a role and affect fetal brain development.

Dr. Xiang uncovered the association between autism and ADHD with maternal diabetes researching the Kaiser Permanente electronic medical records database. Kaiser patients tend to remain in the health maintenance organization long term, often spanning multiple generations.

Children who develop autism have a lifelong disability, while children who have a minor cognitive impairment may have fewer long-term problems, Dr. Xiang noted.

The IQ deficit associated with maternal type 1 diabetes is about four points, Dr. Damm said. And while these children often need tutoring or special instruction in language and math classes, they tend to graduate from elementary and secondary school with average grades.

“When we controlled for the parents’ financial status, education status, and social status, it seems that maternal type 1 diabetes is an independent risk factor,” Dr. Damm said. “The children have extra learning problems, but they end up with the same grades as everyone else. We don’t know if it has any significance later in life.”

In the case of autism, the risk is higher if the mother has pre-existing type 1 diabetes. Pre-existing type 2 and gestational diabetes diagnosed during the first two trimesters also present increased risk. Children of mothers with gestational diabetes diagnosed during the third trimester do not appear to be at elevated risk for neurodevelopmental disorders.

Dr. Damm said his studies, based on Danish population registries and clinical studies, did not include the timing of diabetes diagnosis for mothers.

“Logically, this makes sense because if you have pre-existing diabetes, your child is exposed to elevated glucose through pregnancy,” he said. “But mothers who develop gestational diabetes later probably don’t have that same high glucose during the early weeks of pregnancy.”