Prenatal Exposure to Maternal Diabetes Linked to Psychiatric Disorders

Raquel Nogueira Avelar e Silva, PhD

Although previous research has suggested offspring exposed to maternal diabetes during pregnancy have a higher likelihood to develop psychiatric disorders, including autism spectrum disorders (ADSs) and attention-deficit/hyperactivity disorder (ADHD), follow-up evidence is still limited.

As a result, investigators in a recent study hypothesized that prenatal exposure to maternal diabetes during pregnancy may increase the risk of children developing psychiatric disorders in both childhood and adulthood.

Led by Raquel Nogueira Avelar e Silva, PhD, Department of Clinical Epidemiology, Aarhus University Hospital, the team observed prenatal exposure to maternal diabetes during pregnancy had an association with increased risk of several psychiatric disorders during the first 4 decades of life.

Methods

All live births in Denmark from 1978 - 2016 (n = 2,413,335) were included In a Danish population-based cohort study. Follow-up occurred at the lowest possible age of onset for each group of psychiatric disorders (≥1 year) and ended at the date of first diagnosis, death, or end of study period on December 31, 2016.

Investigators defined exposure as any maternal diabetes diagnosis during pregnancy and classified maternal diabetes into pregestational diabetes (PGDM) and gestational diabetes (GDM).

Within the study, a total of 56,206 offspring (2.3%) were born to mothers with diabetes, including 22,614 in PGDM type 1 diabetes, 6713 in PGDM type 2, and 26,879 in GDM.

Further, outcomes included 10 types of psychiatric disorders, made up of any psychiatric disorder, substance use disorders, schizophrenia, mood disorders, anxiety disorders, eating disorders, personality disorders, intellectual disorders, developmental disorders, and behavioral disorders.

Additionally, hazard ratios (HR) and 95% confidence intervals (CI) were computer using Cox proportional hazards regression models.

Findings

A total of 2,413,335 individuals were born in Denmark during the study period, including 1,239,138 males (51.3%) and a median age of 19.0 years (IQR, 5.8 - 20.8 years).

Investigators noted offspring of mothers with a history of psychiatric illness most often had mothers exposed to maternal diabetes during pregnancy (n = 7428, 9.4%).

Within the 39-year follow-up time, a total of 148,017 (6.4%) offspring received a diagnosis of a psychiatric disorder (n = 146,053 unexposed; n = 1964 exposed).

Data show the incidence rates of any psychiatric disorder per 10,000 person-years were higher among exposed offspring (PGDM = 38.0; GDM = 36.5), in comparison to the unexposed group (n = 35.8).

Further, offspring born to mothers with any diabetes diagnosis during pregnancy had increased risk of developing any psychiatric disorder (HR, 1.15; 95% CI, 1.10 - 1.20), schizophrenia (HR, 1.55; 95% CI, 1.15 - 2.08), and anxiety disorders (HR, 1.22; 95% CI, 1.09 - 1.36).

They observed the same was true in developing intellectual disabilities (HR, 1.29; 95% CI, 1.11 - 1.50), developmental disorders (HR, 1.16; 95% Ci, 1.03 - 1.30), and behavioral disorders (HR, 1.17; 95% CI, 1.06 - 1.27), compared to offspring born to mothers without diabetes diagnosis during pregnancy.

However, no associations of maternal diabetes were observed in those with substance use disorders, mood disorders, eating disorders, and personality disorders in offspring.

Takeaways

In summary, investigators suggested clinical management of maternal diabetes during pregnancy is needed, due to the link between maternal diabetes in pregnancy and increased risk for psychiatric disorders.

“Overall, our findings signal the importance of effective strategies for preventing, screening, and treating diabetes among women of fertile age for women’s health and children’s mental health,” investigators wrote.

The study, “Associations of Maternal Diabetes During Pregnancy With Psychiatric Disorders in Offspring During the First 4 Decades of Life in a Population-Based Danish Birth Cohort,” was published in JAMA Network Open.