Associations of Different Types of Maternal Diabetes and Body Mass Index With Offspring Psychiatric Disorders.
Level 3 - non-randomized controlled study
Nationwide registry-based prospective cohort study
PubMed 32031649 · doi:10.1001/jamanetworkopen.2019.20787
What was done
A nationwide population-based cohort study examined 647,099 live births in Finland from 2004 to 2014 using national health registries. Researchers evaluated the joint and separate associations of maternal prepregnancy body mass index (BMI) and maternal diabetes subtypes (insulin-treated pregestational diabetes, non-insulin-treated pregestational type 2 diabetes, and non-insulin-treated gestational diabetes) with offspring psychiatric diagnoses and psychotropic drug prescriptions. Cox proportional hazards models were adjusted for child sex, birth year, delivery mode, maternal age, parity, plurality, country of birth, marital status, maternal smoking, maternal psychiatric disorder, and maternal systemic inflammatory disease.
What was found
Among 647,099 births, 4,000 fetuses (0.62%) were exposed to insulin-treated pregestational diabetes, 3,724 (0.57%) to type 2 diabetes, and 98,242 (15.18%) to gestational diabetes; 34,892 offspring (5.39%) received a psychiatric or mild neurodevelopmental diagnosis. Compared with normal-weight mothers without diabetes, severe obesity combined with maternal diabetes was associated with increased offspring psychiatric risk: insulin-treated pregestational diabetes had a hazard ratio (HR) of 2.71 (95% CI, 2.03–3.61), type 2 diabetes had an HR of 1.97 (95% CI, 1.64–2.37), and gestational diabetes had an HR of 1.61 (95% CI, 1.50–1.72). The strongest associations occurred for mood disorders, ADHD, conduct disorders, and autism. Diabetes in normal-weight mothers was not associated with psychiatric disorders in offspring.
Why it matters
This study demonstrates that the elevated risk of offspring neurodevelopmental and psychiatric disorders is concentrated in pregnancies complicated by the combination of maternal diabetes and severe obesity, rather than maternal diabetes alone.
Limits
The observational design cannot establish causality. Diagnoses and medication data relied entirely on administrative registries without direct clinical verification. The cohort was predominantly born in Finland (90.6% of mothers), which may limit generalizability to more ethnically diverse populations. Unmeasured familial, genetic, or environmental confounding factors could also account for the observed associations.
Cited by
- supports Women with obesity and type 2 diabetes have an increased risk of giving birth to a child on the autism spectrum compared to normal-weight healthy women.