A study has indicated a potential link between diabetes during pregnancy and an elevated risk of neurodevelopmental disorders such as autism and ADHD in children. While the researchers emphasised the need for further investigation, they highlighted the "imperative" nature of "diligent monitoring" of blood sugar levels throughout pregnancy.

The meta-analysis, carried out by Chinese academics, encompassed 202 studies involving more than 56 million pregnancies. Of these, 110 studies focused on gestational diabetes – a condition that arises during pregnancy and typically resolves post-birth – while 80 examined pre-gestational diabetes, where a woman is diagnosed with type 1 or type 2 diabetes prior to pregnancy.

The analysis revealed that children born to mothers with diabetes during pregnancy had a 28% heightened risk of developing any neurodevelopmental disorder compared to those whose mothers did not have the condition. This was true even in studies that factored in other potential explanatory variables.

Upon examining individual disorders, the researchers discovered a 25% increased risk of autism spectrum disorder (ASD), a 30% increased risk of attention-deficit/hyperactivity disorder (ADHD) and a 32% increased risk of intellectual disability. The risks were more pronounced in women who had diabetes before pregnancy as opposed to those who developed gestational diabetes.

The researchers emphasised the "diligent monitoring of maternal glycaemic concentrations throughout pregnancy is imperative". They stated: "To the best of our knowledge, this is the first comprehensive systematic review and meta-analysis to assess neurodevelopmental outcomes in children born to mothers with specific types of diabetes." The team also cautioned that while their findings, published in The Lancet, offer "provide novel insights into the potential risks", they should be "interpreted with caution".

Reacting to the study, Lucilla Poston, a professor of maternal and foetal health at King's College London, commented: "The human foetus is exquisitely vulnerable to changes in its environment which may affect life-long health."

She further noted that the "well conducted" review "benefits from a focus on studies that ruled out several factors, 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," Prof Poston added. "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."