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.
Level 3 - non-randomized controlled study
Nationwide non-randomized prospective cohort study
PubMed 34648013 · doi:10.1001/jamanetworkopen.2021.28005
What was done
This population-based cohort study analyzed data from Danish nationwide medical and administrative registries covering 2,413,335 live births between 1978 and 2016 (median age 19.0 years, IQR 5.8-20.8 years; follow-up up to 39 years). Exposures were any maternal diabetes diagnosis during pregnancy (56,206 offspring, 2.3%) and subtypes: pregestational type 1 diabetes (22,614 offspring), pregestational type 2 diabetes (6,713 offspring), and gestational diabetes (26,879 offspring). Cox proportional hazards models estimated hazard ratios for 10 psychiatric disorder categories, adjusting for parental psychiatric history, birth period, singleton status, offspring sex, and maternal factors (age, parity, education, smoking, cohabitation, residence, BMI), with sibship and competing risk analyses.
What was found
During follow-up, 151,208 offspring (6.4%) were diagnosed with a psychiatric disorder. Maternal diabetes during pregnancy was associated with increased risks of any psychiatric disorder (HR, 1.15; 95% CI, 1.10-1.20), schizophrenia (HR, 1.55; 95% CI, 1.15-2.08), anxiety disorders (HR, 1.22; 95% CI, 1.09-1.36), 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, 1.08-1.27). No association was observed for substance use disorders, mood disorders, eating disorders, and personality disorders.
Why it matters
This study provides large-scale population evidence that maternal diabetes is associated with a broader spectrum of offspring psychiatric conditions—including schizophrenia and anxiety—extending into early adulthood.
Limits
As an observational registry study, unmeasured confounding and shared familial or environmental factors cannot be fully excluded. Case identification relied on hospital-based registry diagnoses, likely underrepresenting milder psychiatric conditions managed exclusively in primary care. Findings from this Danish cohort may not generalize to populations with different healthcare access or ethnic diversity.
Cited by
- supports A Danish study in JAMA Network found that children born to mothers with diabetes had a 15% higher risk of psychiatric disorders, a 55% higher risk of schizophrenia, a 29% higher risk of intellectual disability, and associations with autism and ADHD.