Maternal diabetes linked to ADHD in their children

Babies born to women with diabetes before or during pregnancy may be at risk for developing attention-deficit/hyperactivity disorder, data from a large multinational cohort study show.

Looking at more than 4.5 million mother-child pairs, it was found that children whose mothers had diabetes around the time of conception were 16% more likely to develop diabetes. ADHD They were diagnosed from those whose mothers did not.

An increased risk was observed regardless of the type of diabetes, and regardless of whether or not diabetes was present before pregnancy or appeared during pregnancy.

“We found a slight increased risk ADHD in children Born to mothers with diabetes, including pre-diabetes and Pregnancy diabetesCaroline Siesta, Ph.D.reported at the annual meeting of the European Association for the Study of Diabetes.

Siesta, a postdoctoral researcher at the Center for Epidemiology of Pharmacoepidemiology at the Karolinska Institutet in Stockholm, noted that the effect sizes seen were lower than previously reported.

“This may be because we adjusted for a large number of covariates, including maternal ADHD and psychiatric disorders,” Siesta said.

ADHD and diabetes

“Previous studies have indicated an increased risk of ADHD in children born to mothers with diabetes,” Siesta explained.

However, “these studies were limited by the use of self-reported data, small sample sizes, lack of adjustment for significant confounders, and are often limited to [White] “There is a lot of heterogeneity between these studies,” she added.

To try to iron out differences seen in previous studies, Cesta and colleagues looked at data from several databases based in Hong Kong (Clinical Data Analysis and Reporting System), four Nordic countries (Population Health Registries for Finland, Iceland, Norway, and Sweden), and Taiwan ( National Health Insurance Database).

To create identical mother-child pairs, databases were searched to find women with children born between 2001 and 2018, who had follow-up data available through 2020 not only on their diabetes status and child ADHD status, But also not that. Parameters, such as the mother’s other diagnoses, the mother’s medications, and a combination of sociodemographic factors.

More than 24 possible or variable variables were considered in the analysis, which used a Cox proportional hazard regression model and propensity score analysis to calculate hazard ratios with 95% confidence intervals.

“We looked at whether [mothers] Self-diagnosed ADHD, or other psychiatric disorders, because there is a high rate of heritability for these disorders,” Siesta said, noting that all bases have sought to cover them.

Main results

The results showed some differences in the prevalence of diabetes and ADHD between the three groups used in the analysis. The prevalence of any maternal diabetes ranged from 8.8% in the Hong Kong group to 3.3% in the Taiwan group, with a prevalence of 6.8% in the Nordic group.

Pre-gestational diabetes rates were lowest in the Taiwan and Hong Kong groups, at 0.2% and 0.5%, respectively, and 2.2% in the Nordic group. Gestational diabetes rates were 3.1%, 7.8%, and 4.6%.

The highest rate of ADHD in children was observed in the Taiwan group, at 9.6%, followed by 4.2% for the Hong Kong group, and 2.6% for the Nordic group.

The hazard ratio for developing ADHD in childhood was 1.16 when comparing any maternal diabetes with no maternal diabetes, 1.40 comparing mothers with and without pre-gestational diabetes, and 1.36 and 1.37 each compared to subjects with and without. type 1 diabetesand those with and without Type 2 diabetes.

The HR rate for childhood ADHD when comparing mothers with or without gestational diabetes was 1.13.

“Within the gestational diabetes analysis, we had enough to look at maternal gestational diabetes incompatible siblings,” Siesta said. Basically, she explained, “We are comparing two siblings of the same mother, one of whom had gestational diabetes, and the other who did not.”

Interestingly, there was no association between ADHD and gestational diabetes in the sibling analysis (HR, 1.0).

“When it comes to gestational diabetes, the evidence from our sibling analysis suggests that the association may actually be confounded by shared genetics and environmental factors,” Siesta said.

“Therefore, future studies should explore the role of specific genetic factors in glycemic control during pregnancy and the relationship between maternal diabetes and ADHD.”

Answering long-standing questions

This data will help a lot in answering the questions that doctors have been asking themselves for a long time, commented Gardena Powder, Physician, who presided over the session.

“It’s still a bit puzzling that genetic and environmental factors are responsible, if you see the same effect in type I. [diabetes]and in type 2 [diabetes]and gestational diabetes,” said Bauder, MD, an endocrinologist and diabetologist in the Department of Women, Mother and Child at the University Hospital Center Vaux, Lausanne, Switzerland.

Type 1 and type 2 are “very distinct” in terms of the genetic and environmental factors involved, “so the fact that you see [the effect] Both are still a bit baffled,” Bodder said.

“I wish we had the numbers to enable us to do a sibling analysis for type 1 and type 2, just to see if we could tease anything,” Siesta said.

“I think that’s part of the bigger question about the relationship between, like, metabolic disorders and psychiatric disorders, because even outside of pregnancy, we see that there’s often comorbidity with them. So, it’s a good point.”

The next step is to consider the role of treatment and the effects that glycemic control may have on the small, but still clear, association between maternal diabetes and ADHD.

The study had multiple funders including the Hong Kong Research Grant Council, NordForsk, the Norwegian Research Council, the Norwegian ADHD Research Network, the Hong Kong Innovation and Technology Commission, and European Horizon 2020.

Cesta had no conflict of interest to disclose. Puder chaired the session in which the findings were presented and did not make any specific disclosures.

This article originally appeared MDedge.compart of the Medscape Professional Network.